[Diabetic nephropathy and ACE inhibitors].
The life expectancy of patients with type 2 diabetes and diabetic nephropathy is reduced; the main cause of death is cardiovascular disease. The majority of patients with renal replacement therapy are type 2 diabetics. Inhibition of the renin-aldosterone-angiotensin system is beneficial in diabetes mellitus. It reduces the incidence and slows the progression of nephropathy. ACE inhibitors are the accepted standard of care for nephropathy in type-1 diabetics; the role of ACE inhibitors versus angiotensin-receptor-blockers in type 2 diabetes is less clear. Large studies from the last 15 years and meta-analyses show a reduction of mortality of about 20% with ACE inhibitors in type 2 diabetic nephropathy; angiotensin-receptor-blockers have no documented effect on mortality yet, but do also slow the progression of nephropathy in type 2 diabetics. From these data and because of economic considerations, ACE inhibitors should be first choice therapy for diabetic nephropathy in type 2 diabetes mellitus.
Amann
B
B
Innere Abteilung Angiologie und Diabetologie, Franziskuskrankenhaus Berlin, Budapester Strasse 15-19, 10787 Berlin, Germany. amann@franziskus-berlin.de
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology*; D018849:Controlled Clinical Trials as Topic; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000401:mortality; D018450:Disease Progression; D006801:Humans; D015201:Meta-Analysis as Topic; D017582:Renal Replacement Therapy; D012084:Renin-Angiotensin System / Q000187:drug effects
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors