Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

CiteULike is a free service for managing and discovering scholarly references - click here to get started.

Sign In to gain access to subscriptions and/or personal tools.
The British Journal of Diabetes & Vascular Disease
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Kumar, R.
Right arrow Articles by Winocour, P. H
Right arrow Search for Related Content
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Reviews

Review: Dual blockade of the renin angiotensin system in diabetes — rationale and risks

Rajeev Kumar

Department of Diabetes and Endocrinology, QE 2 Hospital, Welwyn Garden City, AL7 4HQ, UK, rajeevsr{at}hotmail.com

Peter H Winocour

Diabetic nephropathy is the most common cause of end stage renal failure (ESRF) in the developedof world and as the incidence of diabetes increases this trend will continue, although most of these patients will die of cardiovascular diseases. The renin-angiotensin system (RAS) is believed to play a central role in the development and progression of both micro- and macrovascular complications of diabetes and blocking this system in diabetic patients is critically important. Two widely used inhibitors of RAS are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs affect the system at different levels and thus may have an additive effect. Use of drugs from one class may not be completely effective in blocking this system for several reasons. In this article we discuss issues surrounding the use of dual blockade (i.e. the use of ARB and ACE inhibitors together in patients with diabetic nephropathy responding insufficiently to previous antihypertensive treatment including either ARB or ACE inhibitors) in patients with diabet

Key Words: diabetes mellitus • dual blockade • renin-angiotensin system • hyperkalaemia.

References

  • Ritz E., Rychlik I., Locatalli F., Halami S. End stage renal failure in type 2 diabetes: a medical catastrophe of worldwide dimensions. Am J Kidney Dis 1999;34:795-808.[Web of Science][Medline] [Order article via Infotrieve]
  • Laakso M. Hyperglycaemia and cardiovascular disease in type 2 diabetes. Diabetes 1999;48:937-42.[Abstract]
  • United Kingdom Prospective Diabetes Study Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS 33. Lancet 1998;352:837-53.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ;317:703-13.
  • Angélique ME, Spoelstra-de Man Catherine B., et al. Rapid Progression of Albumin Excretion Is an Independent Predictor of Cardiovascular Mortality in Patients With Type 2 Diabetes and Microalbuminuria. Diabetes Care 2001;24:2097-101.[Abstract/Free Full Text]
  • Parving H-H., sterby R., Ritz E. Diabetic nephropathy. In: Brenner BM, Levine S, Eds. The Kidney 6th edition. Philadelphia, WB Saunders, 2000; 1731-73.
  • Williams B., Poulter N., Brown M. et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 2004; 328:634-40.[Free Full Text]
  • Rosner MH, Okusa MD Combination therapy with angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists in the treatment of patients with type 2 diabetes mellitus. Arch Intern Med 2003; 163:1025-9.[Abstract/Free Full Text]
  • Tomlinson JW, Owen K., Close CF Treating hypertension in diabetic nephropathy. Diabetes Care 2003;26:1802-05.[Abstract/Free Full Text]
  • Winocour PH Effective diabetes care: a need for realistic targets. BMJ 2002;324:1577-80.[Free Full Text]
  • Elliott WJ Therapeutic trials comparing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Curr Hypertens Rep 2000; 2:402-11.[Medline] [Order article via Infotrieve]
  • Lewis EJ, Hunsicker LG, Bain RP et al. for The Collaborative Study Group. The Effect of Angiotensin-Converting-Enzyme Inhibition on Diabetic Nephropathy. N Engl J Med 1993;329;1456-62.[Abstract/Free Full Text]
  • Ravid M., Lang R., Rachmani R. et al. Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus: a 7 year follow-up study. Arch Intern Med 1996;156:286-9.[Abstract/Free Full Text]
  • Parving HH, Lehnert H., Brochner-Mortensen J. et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001;345:870-8.[Abstract/Free Full Text]
  • Brenner BM, Cooper ME, de Zeeuw D. et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001;345:861-9.[Abstract/Free Full Text]
  • Rossing P., Hommel E., Smidt UM et al. Reduction in albuminuria predicts a beneficial effect on diminishing the progression of human diabetic nephropathy during antihypertensive treatment. Diabetologia 1994;37: 511-16.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • American Diabetes Association: clinical practice recommendation 2004. Diabetes Care 2004;27(suppl 1):S1-S150.[CrossRef]
  • Gerstein HC, Yusuf S., Mann JFE et al. for the Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE sub study. Lancet 2000;355;253-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Garg R., Yusuf S., for the Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995;273:1450-6.[Abstract/Free Full Text]
  • Cohn JN, Tognoni G., for the Val-HeFT Investigators. Effects of the angiotensin receptor blocker valsartan on morbidity and mortality in heart failure: The Valsartan Heart Failure Trial (Val-HeFT). Circulation 2000;267:2672-6.
  • Dahlöf B., Devereux RB, Kjeldsen SE et al. for the LIFE study group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359:995-1003.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Pfeffer MA, Swedberg K., Granger CB et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003;362:759-66.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • van den Meiracker AH, Man in 't Veld AJ, Admiraal PJ et al. Partial escape of angiotensin converting enzyme (ACE) inhibition during prolonged ACE inhibitor treatment: does it exist and does it affect the antihypertensive response? J Hypertens 1992;10:803-12.[Web of Science][Medline] [Order article via Infotrieve]
  • Balcells E., Meng QC, Johnson WH Jr et al. Angiotensin II formation from ACE and chymase in human and animal hearts: methods and species considerations. Am J Physiol 1997;273:H1769-H1774.[Web of Science][Medline] [Order article via Infotrieve]
  • Ohishi M., Ueda M., Rakugi H. et al. Upregulation of angiotensin-converting enzyme during the healing process after injury at the site of percutaneous transluminal coronary angioplasty in humans. Circulation 1997; 96:3328-37.[Abstract/Free Full Text]
  • Cao Z., Bonnet F., Candido R. et al. Angiotensin type 2 receptor antagonism confers renal protection in a rat model of progressive renal injury. J Am Soc Nephrol 2002;13:1773-87.[Abstract/Free Full Text]
  • Nickenig G., Baumer AT, Temur Y. et al. Statin-sensitive dysregulated AT1 receptor function and density in hypercholesterolemic men. Circulation 1999;100:2131-4.[Abstract/Free Full Text]
  • Mogensen CE, Neldam S., Tikkanen I. et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000;321:1440-4. 29. Jacobsen P., Andersen S., Rossing K. et al. Dual blockade of the renin-angiotensin system in type 1 patients with diabetic nephropathy. Nephrol Dial Transplant 2002;17:1019-24.[Abstract/Free Full Text]
  • Jacobsen P., Andersen S., Rossing K. et al. Dual blockade of the renin-angiotensin system versus maximal recommended doses of ACE inhibition in diabetic nephropathy. Kidney International 2003;63:1874-80.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Rossing K., Jacobson P., Pietraszek L. et al. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy: A randomized double-blind crossover trial. Diabetes Care 2003;26:2268-74.[Abstract/Free Full Text]
  • Rossing K., Christensen PK, Parving HH Dual blockade of the renin-angiotensin system in diabetic nephropathy: a randomized double-blind crossover study. Diabetes Care 2002;25:95-100.[Abstract/Free Full Text]
  • Andersen NH, Poulsen PL, Knudsen ST et al. Long-term dual blockade with candesartan and lisinopril in hypertensive patients with diabetes: The CALM II study. Diabetes Care 2005;28:273-7.[Abstract/Free Full Text]
  • Palmer BF Managing hyperkalaemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med 2004;351:585-92. 35. Ahuja TS, Freeman D., Mahnken JD et al. Predictors of the development of hyperkalemia in patients using angiotensin-converting enzyme inhibitors. Am J Nephrol 2000;20:268-73.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Reardon LC, Macpherson DS Hyperkalaemia in outpatients using angiotensin converting enzyme inhibitors. Arch Int Med 1998;158;26-32.[Abstract/Free Full Text]
  • Nicholls AJ The impact of atherosclerotic renovascular disease on diabetic renal failure. Diabet Med 2002;19:889-4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Bonnet F., Thivole CH Reversible hyperkalemia at the initiation of ACE inhibitors in a young diabetic patient with latent hyporeninemic hypoaldosteronism (letter). Diabetes Care 1996;19:81.
  • Ruilope LM, Aldigier JC, Ponticelli C. et al. on behalf of the European Group for the Investigation of Valsartan in Chronic Renal Disease. Safety of the combination of valsartan and benazepril in patients with chronic renal disease. J Hypertension 2000;18:89-95.[Web of Science][Medline] [Order article via Infotrieve]
  • Struthers AD Aldosterone: cardiovascular assault. Am Heart J 2002; 144:S2-S7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Rachmani R., Slavachevsky I., Amit M. et al. The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomised controlled study. Diabet Med 2004;21:471-5.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
  • Sato A., Hayashi K., Naruse M. et al. Effectiveness of aldosterone blockade in patients with diabetic nephropathy. Hypertension 2003;41:64-8.[Abstract/Free Full Text]
  • Krum H., Nolly H., Workman D. et al. Efficacy of eplerenone added to renin-angiotensin blockade in hypertensive patients. Hypertension 2002; 40:117-23.[Abstract/Free Full Text]
  • Epstein M., Buckalew V., Altamirano J. et al. Eplerenone reduces proteinuria in type II diabetes mellitus: implications for aldosterone involvement in the pathogenesis of renal dysfunction. J Am Coll Cardiol 2002; 39(suppl A):249A.Abstract.

The British Journal of Diabetes & Vascular Disease, Vol. 5, No. 5, 266-271 (2005)
DOI: 10.1177/14746514050050050501
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Kumar, R.
Right arrow Articles by Winocour, P. H
Right arrow Search for Related Content
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?