Angiotensin receptor blockade in diabetic renal disease--focus on candesartan.
Prevention and regression of diabetic renal disease can be obtained through the combination of strict blood pressure control, which frequently requires the combination of different antihypertensive drugs, with tight glycaemic control. Recent evidence obtained with the angiotensin receptor blockers has allowed the recognition by most guidelines that this class of agents constitutes the first choice to treat hypertension in type 2 diabetic patients presenting with diabetic renal disease at any stage of evolution, from microalbuminuria to advanced renal failure. Of course this must be accompanied by an integral coverture of the increased global cardiovascular risk that always accompanies this situation. This short review contains the most relevant evidence in favour of angiotensin receptor blockers, with particular emphasis on the capacities of candesartan for controlling blood pressure and protecting the kidney. In patients with type 2 diabetes and varying degrees of albuminuria, treatment with candesartan 8-32mg daily was shown to reduce urinary albumin excretion (UAE) by up to 60%. When given in addition to an ACE inhibitor (dual blockade), reductions in UAE of 25-35% relative to ACE inhibitor monotherapy have been found.
García Donaire
José A
JA
Hypertension Unit, Hospital 12 de Octubre, Av. Cordoba s/n, 28041 Madrid, Spain.
Ruilope
Luis M
LM
D047228:Angiotensin II Type 1 Receptor Blockers / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D003925:Diabetic Angiopathies / Q000517:prevention & control; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D012079:Renal Circulation / Q000187:drug effects / Q000502:physiology; D013777:Tetrazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan