title: The role of angiotensin receptor blockers in diabetic nephropathy.
abstract: BACKGROUND
  Hypertension and diabetes are common risk factors for nephropathy as well as for neuropathy, retinopathy, cardiovascular disease, and cerebrovascular disease. Diabetic nephropathy occurs in 20% to 40% of patients with type 2 diabetes mellitus and is the single most important cause of end-stage renal disease (ESRD) worldwide, accounting for 40% to 45% of new cases in the United States. The incidence of ESRD is predicted to increase as the prevalence of type 2 diabetes mellitus and obesity continue to increase.
  
  
  METHODS
  Clinical data from the recent classes of antihypertensive agents are reviewed in the context of hypertension reduction guidelines and prevention of diabetic nephropathy.
  
  
  RESULTS
  Numerous clinical trials have demonstrated that angiotensin receptor blockers (ARBs) are safe and effective antihypertensive treatments that slow the progression of renal disease in people with diabetes and/or hypertension, and macroalbuminuria.
  
  
  CONCLUSIONS
  The tolerable adverse event profile of ARBs and their renoprotective benefits beyond blood pressure reduction make ARBs a useful first-line treatment in people with, or at risk of developing, renal disease. As the incidence of obesity-related cardiovascular disease and renal risk factors continues to grow, future studies are required to directly assess the renoprotective effects of ARBs in overweight or obese patient subgroups. Because renin angiotensin system (RAS) inhibitors target the key mechanisms underlying these conditions, they may be particularly beneficial for the prevention of ESRD in the growing group of patients with obesity-related hypertension and the metabolic syndrome.
authors.affiliation: Obesity Research and Management, University of Alberta, Royal Alexandra Hospital, Edmonton, AB, Canada. amsharm@ualberta.ca
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000419:Albuminuria / Q000188:drug therapy / Q000517:prevention & control; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism; D009765:Obesity / Q000150:complications / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000502:physiology; D012307:Risk Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents