This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Bilous, R. W Search for Related Content Social Bookmarking                         What's this?

Angiotensin II receptor blockade and type 2 diabetic nephropathy

Audrey Collins Teaching Unit, Education Centre, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK, r.w.bilous{at}ncl.ac.uk

ACE inhibitors have been shown to reduce albuminuria and slow the progression of nephropathy in type 1 diabetes. There are fewer data in type 2 patients.

Three large studies: IRbesartan in patients with type 2 diabetes and MicroAlbuminuria Study (IRMA2), Irbesartan Diabetic Nephropathy Trial (IDNT) and Reduction in End points in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL), of the angiotensin II receptor blockers (ARBs) irbesartan and losartan in microalbuminuric (IRMA2) and nephropathic (IDNT and RENAAL) patients have recently been published. They compared ARBs to conventional treatment, and one used amlodipine as a comparator (IDNT).

IRMA2 showed that irbesartan reduced albuminuria in a dose-dependent fashion, achieving a magnitude of response similar to that seen in type 1 diabetic patients. The adjusted hazard ratio for progressing to nephropathy was 0.32 for patients treated with irbesartan 300 mg.

IDNT and RENAAL showed that irbesartan 300 mg or losartan 100 mg reduced by 16—19% the numbers of patients reaching a combined end point of doubling of baseline serum creatinine, end-stage renal failure, or all-cause mortality. This effect was not seen in amlodipine treated patients, implying a specific benefit of ARBs.

ARBs should be considered as first line therapy in both early and established type 2 diabetic nephropathy.

Key Words: angiotensin II • angiotensin receptor antagonists • diabetic nephropathy.

The British Journal of Diabetes & Vascular Disease, Vol. 2, No. 2, 101-105 (2002)
DOI: 10.1177/14746514020020020701


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				H.-M. Jin and Y. Pan Angiotensin type-1 receptor blockade with losartan increases insulin sensitivity and improves glucose homeostasis in subjects with type 2 diabetes and nephropathy Nephrol. Dial. Transplant., July 1, 2007; 22(7): 1943 - 1949. [Abstract] [Full Text] [PDF]

				A. Brady Lust for LIFE: losartan and type 2 diabetes: Cardiovascular morbidity and mortality in patients with diabetes in the LIFE study The British Journal of Diabetes & Vascular Disease, January 1, 2003; 3(1): 45 - 46. [PDF]

				P. Andrews NICE guidelines: renal disease -- prevention and early management The British Journal of Diabetes & Vascular Disease, July 1, 2002; 2(4): 309 - 310. [PDF]