ACE inhibitors and protection against kidney disease progression in patients with type 2 diabetes: what's the evidence.
Although angiotensin-converting enzyme inhibitors are frequently used as antihypertensive agents to lower blood pressure and slow progression of nephropathy in patients with type 2 diabetes, evidence of their efficacy has been drawn primarily from small trials with surrogate end points. No adequately powered, long-term trials have tested their effects to reduce the incidence of hard end points, such as progression to end-stage renal disease or even doubling of serum creatinine in the population of patients with nephropathy from type 2 diabetes. While the results of angiotensin-converting enzyme inhibitor trials from nondiabetic causes and even type 1 diabetes may be extrapolated to the patient with nephropathy associated with type 2 diabetes, the hard evidence is not available. This review critically evaluates the limited evidence in support of angiotensin-converting enzyme inhibitors as renal-protective agents in people with type 2 diabetes.
Bakris
George L
GL
Department of Preventive Medicine, Rush-Presbyterian-St. Lukes Medical Center, Chicago, IL 60612, USA. gbakris@rush.edu
Weir
Matthew
M
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000201:enzymology; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000201:enzymology
D000806:Angiotensin-Converting Enzyme Inhibitors