The renin-angiotensin system and its blockade in diabetic renal and cardiovascular disease.
Diabetic nephropathy, the most common cause of end-stage renal disease in the United States, is also associated with increased cardiovascular mortality. The renin-angiotensin-aldosterone system (RAAS) plays a central role in the development and progression of kidney disease and cardiovascular disease. Randomized, controlled trials have demonstrated renoprotection with the use of angiotensin receptor blockers (ARBs) in type 2 and angiotensin-converting enzyme inhibitors (ACEIs) in type 1 diabetes. More recent studies have demonstrated similar cardiovascular benefits with the use of ARBs compared with ACEIs. The combination of the two classes of RAAS blockers has been investigated in large studies of patients with heart failure and after myocardial infarction, and a few small studies of patients with diabetic nephropathy. In this review, we summarized the results of the studies on the benefits of ARBs, ACEIs, and their combination in patients with diabetic nephropathy or cardiovascular diseases.
Kalantarinia
Kambiz
K
Division of Nephrology, University of Virginia Health System, Box 800 133, Charlottesville, VA 22908, USA. kk6c@virginia.edu
Okusa
Mark D
MD
D000450:Aldosterone / Q000502:physiology; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000503:physiopathology* / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000503:physiopathology* / Q000517:prevention & control; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000502:physiology*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000450:Aldosterone