This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (8)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Review  • Drug Therapy, Other  • Diabetes Mellitus  • Alert me on articles by topic  Social Bookmarking   What's this?

Mitchell H. Rosner, MD; Mark D. Okusa, MD

Arch Intern Med. 2003;163:1025-1029.

Aggressive therapy for patients with type 2 diabetes mellitus and renal disease is warranted given the natural history of this disease. Although antagonizing the renin-angiotensin system is clearly important, how this is accomplished is of considerable controversy. On the one hand, recent clinical trials of patients with type 2 diabetes mellitus with renal disease demonstrate unequivocally the renal protective effect of angiotensin receptor blockers (ARBs). Although the results of the recently published LIFE trial are encouraging, inconsistencies have been observed with ARBs in reducing cardiovascular end points. On the other hand, angiotensin-converting enzyme inhibitors have a dramatic effect in reducing cardiovascular events but have not been shown convincingly to reduce progression of renal disease in patients with type 2 diabetes mellitus. These studies leave us in a quandary as to the optimal initial treatment regimen for patients with type 2 diabetes mellitus and renal disease despite the recent recommendations from the American Diabetes Association (Alexandria, Va). Given the fact that many of these individuals will require administration of multiple antihypertensive agents, perhaps the initial treatment with a combination of an ARB and angiotensin-converting enzyme inhibitor affords optimal cardiovascular and renal protection for patients with type 2 diabetes mellitus and renal disease. Future clinical trials should be designed to address this issue.

From the University of Virginia Health Sciences Center, Division of Nephrology, Department of Internal Medicine, Charlottesville, Va. The authors have no relevant financial interest in this article.

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

ACE Inhibitor or Angiotensin II Receptor Antagonist Attenuates Diabetic Neuropathy in Streptozotocin-Induced Diabetic Rats
Coppey et al.
Diabetes 2006;55:341-348.
ABSTRACT | FULL TEXT  

Review: Dual blockade of the renin angiotensin system in diabetes -- rationale and risks
Kumar and Winocour
British Journal of Diabetes & Vascular Disease 2005;5:266-271.
ABSTRACT  

Masterclass series in peripheral arterial disease: Hypertension and peripheral arterial disease
Olin
Vasc Med 2005;10:241-246.
 

Should a Diuretic Always Be the First Choice in Patients with Essential Hypertension? The Case for No
Morganti
J. Am. Soc. Nephrol. 2005;16:S70-S73.
ABSTRACT | FULL TEXT  

Dual Blockade of the Renin-Angiotensin System in Diabetic Nephropathy
JWatch General 2003;2003:2-2.
FULL TEXT