Antihypertensive, antiproteinuric therapy and myocardial infarction and stroke prevention.
Proteinuria is a graded marker for kidney damage, as well as the risk for future cardiovascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) reduce urinary protein excretion and slow progression of renal impairment, independent of blood pressure lowering. Both the Irbesartan Diabetic Nephropathy Trial (IDNT) and the Reduction in Endpoints in NIDDM with the Angiotensin Antagonist Losartan (RENAAL) study were large, randomized, prospective studies in type 2 diabetic patients with proteinuria. There was no reduction in the incidence of myocardial infarction or stroke with the ARBs compared to placebo in either trial. A broader overview of clinical trials comparing ACEIs and ARBs with other antihypertensive drugs fails to show any substantive blood pressure-independent effects on stroke or myocardial infarction with these classes of drugs. Therefore, for cardiovascular end points (as opposed to renal end points), it may be more important that the blood pressure is reduced, rather than how the process is started.
Choi
Kenneth L
KL
Department of Preventive Medicine, RUSH Medical College, 1700 West Van Buren Street, Suite 470, Chicago, IL 60612, USA.
Elliott
William J
WJ
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D009203:Myocardial Infarction / Q000517:prevention & control*; D011507:Proteinuria / Q000517:prevention & control*; D020521:Stroke / Q000517:prevention & control*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers