Therapeutic controversies in hypertension management: angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers in diabetic nephropathy? ACE inhibitors.
نویسندگان
چکیده
Diabetic nephropathy is the number one cause of endstage renal disease in the United States. Blood pressure is most important in delaying the progression of renal disease in persons with diabetes and, agents that block the renin angiotensin system (RAS) should be the primary agents used to achieve blood pressure reduction. There is debate regarding which method of RAS blockade should be used as primary therapy in persons with diabetes. There are not significant differences between angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) with regard to renal outcomes. Consideration of the enormously high rates of cardiovascular disease (CVD) in persons with diabetes and renal disease is the primary factor in choosing agents for blood pressure reduction. The ACE inhibitors and ARBs have been shown to reduce cardiovascular events in persons with diabetes and, there are recent comparable trials between the 2 classes. Some studies and meta-analyses show ACE inhibitors as being superior with regard to cardioprotection. In our nephrology clinic, we find that patients who presented on an ACE inhibitor had significantly lower CVD than those on ARBs (49.2% vs 70.1% prevalence of CVD, ACE inhibitor vs ARB respectively, P=.042). We conclude that ACE inhibitors should be strongly considered as the primary method of RAS inhibition in persons with diabetes.
منابع مشابه
Therapeutic controversies in hypertension management: angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers for diabetic nephropathy? A case for ACE inhibitors.
Diabetic nephropathy is the number one cause of endstage renal disease in the United States. Blockade of the renin angiotensin system (RAS) is important in the treatment of diabetic nephropathy. With the reports of recently completed trials examining the role of angiotensin receptor blockers (ARBs) in type 2 diabetic nephropathy, the question has arisen as to which agents are best to block the ...
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ورودعنوان ژورنال:
- Ethnicity & disease
دوره 14 4 شماره
صفحات -
تاریخ انتشار 2004