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Acei In Diabetes

Effects Of Acei/arb In Hypertensive Patients With Type 2 Diabetes Mellitus: A Meta-analysis Of Randomized Controlled Studies

Effects Of Acei/arb In Hypertensive Patients With Type 2 Diabetes Mellitus: A Meta-analysis Of Randomized Controlled Studies

Abstract The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM. PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM. Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality. Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM. Background Hypertension and type 2 diabetes (T2 DM) frequently coexist, and patients with this combination are at a higher risk for cardiovascular (CV) events than those suffering from hypertension or T2 DM alone [1–3]. Most (60% to 80%) people with T2 DM die of CV complications, and up to 75% of specific CV complications have been attributed to high blood pressu Continue reading >>

What Are The Indications For Treatment With Angiotensin-converting Enzyme (ace) Inhibitors In Patients With Diabetes?

What Are The Indications For Treatment With Angiotensin-converting Enzyme (ace) Inhibitors In Patients With Diabetes?

What are the indications for treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with diabetes? University of Colorado Health Sciences Center Denver Health 1. Grossman E, Messerli FH, Golbourt U. Arch Int Med 2000;160:2447-52. 2. Hansson L, et al. Lancet 1999;353:611-16. 3. Hansson L, Zanchetti A, Carruthers SG, et al. for the HOT study group. Lancet 1998;351:1755-62. 4. United Kingdom Prospective Diabetes Study Group. BMJ 1998;317:713-20. 5. Sigal R, Malcolm J. BMJ Clin Ev 2001;5:376-90. 6. Estacio RO, Jeffers BW, Hiatt WR, et al. N Engl J Med 1988;338:645-52. 7. Tatti P, Pahor M, Byington RP. Diabetes Care 1998;21:597-603. 8. Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Lancet 2000;355:253-59. 9. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. N Engl J Med 1993;329:1456-62. 10. Ravid M, Lang R, Rachmani R, Lishner M. Arch Intern Med 1996; 156:286-89. Lovell HG. In: The Cochrane library, issue 3; 2000. 11. Lovell HG. In: The Cochrane Library, issue 3; 2000. Tight control of hypertension treatment is key in preventing the vascular complications of diabetes. ACE inhibitors appear to have a protective effect that is independent of their antihypertensive effect. Unless there is a contraindication, all patients with diabetes who have hypertension should be treated with ACE inhibitors. Patients with diabetes who have microalbuminuria should be treated with ACE inhibitors, even if normotensive, as should those with overt nephropathy. (Grade of recommendation: A, based on randomized controlled trials.) Several large randomized controlled trials, have demonstrated that control of hypertension in patients with diabetes prevents development or progression of nephropathy, retinopathy, and cardiovascular conditions. 1 - 5 On the basis of these Continue reading >>

Acei In Diabetes Mellitus - General Practice Notebook

Acei In Diabetes Mellitus - General Practice Notebook

The role of ACE inhibitors in patients with diabetics has been investigated in the studies such as the: the HOPE study (n=9,297, 38% with diabetes) provided evidence that ramipril significantly reduced the risk of MI, stroke or cardiovascular death compared with placebo over five years (14.0% vs. 17.8%; NNT 27) - benefits were especially evident in the subgroup of patients with diabetes it has been suggested that these effects of ramipril are beyond those that could be expected from its BP lowering properties - however, this has been disputed by meta-analyses that suggest, for most cardiovascular outcomes, BP lowering effects account for the majority of the benefits seen with different antihypertensives (1) ACE inhibitors slow the progression of renal disease in type I diabetes independent of the effects of blood pressure. There is mounting evidence that the same is true in type II diabetes. The benefits of treatment with ACE inhibitors may result from reducing proteinuria and reducing blood pressure (these effects are not specific to ACE inhibitors) and via direct effects of angiotensin II on glomerular haemodynamics, inflammation, slcerosis and fibrosis (3). Note it has been suggested that thiazide diuretics should be the first-line treatment for diabetic patients with hypertension based on study evidence such as ALLHAT (2) (see linked item): "..Thiazide diuretics are a suitable first choice in people with type 2 diabetes. ACE inhibitors are a reasonable alternative to a thiazide if these are unsuitable, or addition to a thiazide if further BP lowering is required. ACE inhibitors should be used first-line in people with type 2 diabetes if they have renal disease..." A meta-analysis of the use of angiotensin receptor blockers as antihypertensive treatment for patients Continue reading >>

Ace Inhibitors: Blood Pressure Control In Diabetes

Ace Inhibitors: Blood Pressure Control In Diabetes

ACE Inhibitors: Blood Pressure Control in Diabetes Angiotensin converting enzyme (ACE) inhibitors are oral medications that lower blood pressure. ACE inhibitors are used to treat hypertension (high blood pressure), coronary artery disease and heart failure, and to help to control the progression of diabetes and kidney disease. These disease processes tend to go hand in hand; high blood pressure is very common among people with diabetes. High blood pressure also contributes to the development of diabetic nephropathy (kidney disease). Furthermore, those with diabetes tend to have worse outcomes (longer hospitalizations, longer recovery times and higher risks of infection) from major heart problems. Therefore, health-care providers treat hypertension in concert with diabetes . While ACE inhibitors don't directly lower blood sugar, they can contribute to blood sugar control by increasing the bodys sensitivity to insulin. Insulin helps the body metabolize glucose (sugar) and move it from the bloodstream into cells, where it acts as a source of energy. Many ACE inhibitors are available in the United States, including Capoten (captopril), Prinivil and Zestril (lisinopril), Vasotec (enalapril), Lotensin (benazepril), Altace (ramipril), Accupril (quinapril), Monopril (fosinopril), Mavik (trandolapril), Aceon (perindopril) and Univasc (moexipril). ACE inhibitors lower blood pressure by preventing the body from producing the hormone angiotensin II. Angiotensin II causes vasoconstriction (narrowing of blood vessels) and fluid retention, resulting in hypertension. By reducing blood pressure and fluid retention, ACE inhibitors help to control heart failure. ACE inhibitors may also prevent and control diabetic nephropathy (kidney disease) and help control diabetic retinopathy (eye pr Continue reading >>

The Use Of Ace Inhibitors

The Use Of Ace Inhibitors

The Kidneys and Diabetes Back to Related Health Issues ACE inhibitors, are drugs normally used for the treatment of high blood pressure. This is a category of drugs called Angio-Converting Enzyme inhibitors – ACE for short. ACE is an enzyme found in our bodies which activates a hormone called angiotensin causing the blood vessels to constrict, so raising blood pressure and putting pressure on the heart. ACE inhibitors prevent the action of angiotensin resulting in a lowering of blood pressure. However, there is evidence that the use of ACE inhibitors in people who start to show small amounts of protein in the urine, helps to reduce the progression to macroalbuminuria. In other words the use of ACE inhibitors has a protective effect on the kidneys, even in people whose blood pressure is normal. What does the research show? A meta-analysis [Ann Intern Med 2001 March ; 134[5] 370-9] was published on this subject. This is an analysis of studies to provide better evidence than just looking at individual studies. In this case, the studies were selected on the following basis: They included at least 10 people with Type 1 diabetes who had microalbuminuria and normal blood pressure. They had a control group who were not treated with ACE inhibitors [placebo group] They had follow up results at least a year later. 12 studies were selected with a total of 698 patients. The results showed: The progression to macroalbuminuria was reduced in patients receiving ACE inhibitors. After two years the albumin excretion rate was 50.5% lower in treated patients than in those receiving a placebo [no treatment]. For patients with normal blood pressure, Type 1 diabetes and microabluminuria, ACE inhibitors significantly reduced progression to macroalbuminuria and also increased the chances of r Continue reading >>

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Type 2 Diabetes Mellitus With Angiotensin-converting-enzyme Inhibitors

Currently, ACE inhibitors and angiotensin II-receptor blockers are recommended to prevent cardiovascular disease and nephropathy in patients with type 2 diabetes.[ 3 , 7 , 26 ] Clinical data from randomized controlled trials have validated the physiological effects of angiotensin II on the pancreas. Though none of the trials involving ACE inhibitors used new-onset diabetes as a primary endpoint and each trial had its own limitations, the reproducibility of the results is encouraging. The Captopril Prevention Project (CAPPP) was a prospective, randomized, open-label trial with a blinded endpoint evaluation.[ 27 ] The objective of this study was to compare cardiovascular morbidity and mortality in hypertensive patients using an ACE inhibitor or conventional antihypertensive treatment, which included diuretics (most commonly hydrochlorothiazide and bendrofluazide) and -blockers (most commonly atenolol and metoprolol). A total of 10,985 patients age 25-66 years with a diastolic blood pressure of 100 mm Hg on two occasions were enrolled and randomly assigned to receive either captopril (50-200 mg daily) or conventional antihypertensive treatment for 6.1 years. New-onset diabetes mellitus, defined per 1985 World Health Organization criteria,[ 28 ] was set as a secondary outcome for this study. At baseline, diabetes was more prevalent in the captopril group (5.6%) than the conventional therapy group (4.8%). However, by the studys end, the prevalence of diabetes mellitus in the captopril-treated group was significantly less than that in the conventional treatment group (RR, 0.86; 95% CI, 0.74-0.99; p = 0.039). Two major concerns noted about the trial were the randomization method and the control medications used. Patients were randomized using a computer-generated number seque Continue reading >>

Do Ace Inhibitors Prevent Nephropathy In Type 2 Diabetes Without Proteinuria?

Do Ace Inhibitors Prevent Nephropathy In Type 2 Diabetes Without Proteinuria?

Angiotensin-converting enzyme (ACE) inhibitors make a significant difference for patients with diabetes as a whole. If patients both with and without microalbuminuria are included together, ACE inhibitors significantly reduce the progression of the albumin excretion rate (strength of recommendation [SOR]: A, based on multiple randomized controlled trials) and the development of overt nephropathy (SOR: A, based on 1 randomized controlled trial). However, studying diabetes without microalbuminuria separately, the effect of ACE inhibitors on progression to nephropathy does not reach statistical significance. This applies to both type 1 and 2 diabetes (SOR: A, based on randomized controlled trials with heterogenous results). Results are contradictory regarding whether ACE inhibition delays new onset of diabetic microalbuminuria. There are 3 prospective randomized controlled trials studying the effect of ACE inhibitors on albumin excretion for patients with diabetes who do not have microalbuminuria. A 2-year randomized controlled trial compared lisinopril (Prinivil; Zestril) 10 mg/d with placebo in 530 normotensive adults (aged 20–59 years) with insulin-dependent diabetes, defined as those diagnosed with diabetes before age 36 and using continuous insulin therapy within 1 year of diagnosis. At the beginning of the study, 90 patients had microalbuminuria—defined as an albumin excretion rate (AER) >29 mg/24 hr—and 440 patients did not. When the results for all patients who had and did not have microalbuminuria were combined, there was a significantly smaller rise in the AER for the lisinopril group vs the placebo group (3.2 mg/24 hr lower; P=.03). However, for the patients without initial microalbuminuria, the reduction in the rise of AER with lisinopril was not signific Continue reading >>

Renoprotective Effect Of Angiotensin-converting Enzyme Inhibitors And Angiotensin Ii Receptor Blockers In Diabetic Patients With Proteinuria

Renoprotective Effect Of Angiotensin-converting Enzyme Inhibitors And Angiotensin Ii Receptor Blockers In Diabetic Patients With Proteinuria

Abstract Background/Aims: Limited evidence exists on the choice of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in diabetic patients with nephropathy. We aim to assess the renal effectiveness and safety of these drugs among diabetic nephropathy patients. Methods: This retrospective cohort study was conducted with diabetic nephropathy patients who initiated ACEI or ARB monotherapy. The primary outcome was a composite of end stage of renal disease and renal transplantation, and the secondary outcome was all-cause mortality. The safety endpoint was hyperkalemia. Results: Three thousand seven hundred and thirty-nine ACEI users and 3,316 ARB users were identified. ARBs seemed to be inferior to ACEIs given their poorer renal outcome (HR 1.31; 95% CI, 1.15-1.50) and higher risk of hyperkalemia (HR 1.17; 95% CI, 1.04-1.32). Among the four ACEIs compared, captopril was an inferior treatment choice given its poorer renal outcomes (HR 1.42; 95% CI, 1.05-1.93) and higher mortality rate (HR 1.25; 95% CI, 1.01-1.55). Irbesartan appeared to be a poorer treatment choice among the three ARBs compared, given its inferior renal protective effect (HR 1.35; 95% CI, 1.03-1.78). Conclusions: Our findings suggest ACEIs as a relatively more renoprotective and safer treatment as compared to ARBs. Captopril and irbesartan may be inferior to the other ACEIs and ARBs respectively. © 2017 The Author(s). Published by S. Karger AG, Basel Introduction Diabetic nephropathy is a common complication among patients with diabetes mellitus (DM) and the leading cause of chronic kidney disease (CKD) in developed countries [1]. It involves an increase in proteinuria and decrease in glomerular filtration rate. The continuous kidney damage can lead to irreversible Continue reading >>

Using Ace Inhibitors Appropriately

Using Ace Inhibitors Appropriately

When first introduced in 1981, angiotensin-converting enzyme (ACE) inhibitors were indicated only for treatment of refractory hypertension. Since then, they have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, diabetes mellitus, chronic renal insufficiency, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are, in part, attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction, altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include decreases in myocardial infarction (fatal and non-fatal), reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications. Cardiovascular disease affects one in four Americans. According to the American Heart Association, heart and related diseases are expected to cost Americans more than $329 billion in 2002. An estimated 10 million persons in this country are known to have diabetes and 3.6 million to have renal disease, incurring annual health care costs of $98 billion and $11 billion, respectively. Although angiotensin-converting enzyme (ACE) inhibitors have documented clinical benefits in a variety of clinical situations, the disparity between the evidence from clinical trials and bedside medicine is well documented. The National Registry of Myocardial Infarction 2 found that fewer than one half of patients surviving acute myocardial infarction who were candidates for therapy with ACE inhibitors received these life-saving drugs at discharge.1 A recent review of patients with asymptomatic l Continue reading >>

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Role Of Ace Inhibitors In Patients With Diabetes Mellitus.

Abstract The adjective 'epidemic' is now attributed to the rapidly growing number of patients with diabetes mellitus, mainly type 2. and the specific complications linked to this disorder. Provided they are recognised early enough, these different complications can be treated; in some patients the evolutive course of these complications can be slowed or even stopped. Furthermore, some recent observations suggest that specific tissular lesions may be prevented or even reversed. Although glycaemic control is essential, other therapeutic measures that must also be taken include those to control blood pressure and to lower lipid levels. Of the agents available to control the complications of diabetes mellitus, cardiovascular drugs, and particularly ACE inhibitors, have a pre-eminent place. Experimental and epidemiological data suggest that activation of the renin-angiotensin-aldosterone system plays an important role in increasing in the micro- and macrovascular complications in patients with diabetes mellitus. Not only are ACE inhibitors potent antihypertensive agents but there is a growing body of data indicating that also they have a specific 'organ-protective' effect. For the same degree of blood pressure control, compared with other antihypertensive agents, ACE inhibitors demonstrate function and tissue protection of considered organs. ACE inhibitors have been reported to improve kidney, heart, and to a lesser extent, eye and peripheral nerve function of patients with diabetes mellitus. These favourable effects are the result of inhibition of both haemodynamic and tissular effects of angiotensin II. Finally, there are a growing number of arguments favouring the use of ACE inhibitors very early in patients with diabetes mellitus. Continue reading >>

Ace-inhibitors And New-onset Diabetes

Ace-inhibitors And New-onset Diabetes

1 - Epidemiology Type 2 diabetes is a major risk factor for cardiovascular mortality and morbidity. The prevalence of diabetes is increasing worldwide causing tremendous social economic burden to patients and health care providers. Effective strategies for the prevention of diabetes include diet and exercise in order to reduce insulin-resistant fatty tissue and improve insulin sensitivity 1. Randomised trials have convincingly demonstrated that lifestyle changes are associated with a convincing reduction in the progression to diabetes 1. However, the implementation of lifestyle modifications is challenging and therefore, new strategies for the prevention of diabetes are warranted. 2 - Preventive Treatment Peroxisome-proliferator-activated receptor (PPAR) agonists which are known to improve insulin sensitivity and metformin have been shown to reduce the incidence of diabetes 2. In addition, various clinical trials in more than 66,608 patients with coronary artery disease, hypertension, or heart failure have demonstrated a delay and/or prevention of new-onset diabetes with substances directed to inhibit the renin-angiotensin system (RAS) 3-6. However, in all these studies, the incidence of diabetes was not the primary endpoint and in most of the studies results were obtained from post-hoc analyses. In addition, glucose levels were not systematically reviewed. Since inhibition of the RAS is an effective and widely used method for reducing mortality and morbidity in patients with cardiovascular disease, additional positive effects on plasma glucose levels would be intriguing. 3 - The Dream Trial In order to further elucidate the effect of inhibitors of the RAS and the incidence of diabetes the Diabetes Reduction Assessment of Ramipril and Rosiglitazone Medications (DREAM) t Continue reading >>

No Benefit Of Ace Inhibitors/statins For Teens With Type 1 Diabetes

No Benefit Of Ace Inhibitors/statins For Teens With Type 1 Diabetes

Kidney News Features No Benefit of ACE Inhibitors/Statins for Teens with Type 1 Diabetes No Benefit of ACE Inhibitors/Statins for Teens with Type 1 Diabetes Treatment with angiotensin-converting enzyme (ACE) inhibitors, statins, or both does not affect albumin excretion in adolescents with type 1 diabetes, concludes a trial in The New England Journal of Medicine. In a screening study of 4407 adolescents with type 1 diabetes, 1287 had increased albumin excretion, defined as the upper third of the albumin-to-creatinine ratio. Of these, 443 were randomly assigned to treatment with an ACE inhibitor, statin, or matching placebos in a 2-by-2 factorial design. The main outcome of interest was change in albumin excretion, assessed every 6 months over 2 to 4 years. Secondary outcomes included microalbuminuria, retinopathy, lipid levels, and other cardiovascular risk markers. Change in albumin-to-creatinine ratio over time was unaffected by treatment with ACE inhibitor and/or statin. The incidence of microalbuminuria was lower with ACE inhibitor compared to placebo, but this difference was not considered significant. Statin treatment was associated with expected changes in lipid levels. However, there were no between-treatment differences in carotid intima-media thickness, other cardiovascular risk markers, glomerular filtration rate, or retinopathy progression. No serious unexpected adverse reactions occurred. In adolescents with type 1 diabetes, puberty-associated increases in albumin excretion occur before the development of microalbuminuria and macroalbuminuria. This suggests that ACE inhibitors or statins might have beneficial effects for young diabetics with high albumin excretion. However, the randomized, placebo-controlled trial shows no significant difference in albumin Continue reading >>

Ace Inhibitors

Ace Inhibitors

A class of medicine usually used to treat high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors also appear to protect people with diabetes from diabetic nephropathy (kidney disease). People with diabetes are especially prone to hypertension (defined as a blood pressure level of 140/90 mm Hg or greater). Some 20% to 60% of individuals with diabetes have high blood pressure. Hypertension increases their risk not only of heart disease and stroke, but also of peripheral vascular disease, diabetic retinopathy, diabetic nephropathy, and possibly diabetic neuropathy. The American Diabetes Association (ADA) currently recommends a target blood pressure level of under 130/80 mm Hg in people with diabetes. The ADA recommends a number of different measures for lowering blood pressure, including weight loss, sodium restriction, and exercise. When these measures aren’t enough, the addition of one or more medicines is warranted. There are several different classes of blood pressure drugs, including angiotensin-receptor blockers (ARBs), diuretics, beta blockers, and ACE inhibitors. Overall, drug therapy has been shown to substantially decrease the risk of cardiovascular disease, diabetic retinopathy, and diabetic nephropathy. ACE inhibitors may have a special advantage in terms of slowing the progression of diabetic nephropathy. Research findings show that ACE inhibitors can slow the progression of kidney disease to a greater degree than other antihypertensive drugs that lower blood pressure by a similar amount and that they may be able to protect the kidneys even in people with diabetes whose blood pressure levels are in the normal range. This suggests that ACE inhibitors protect the kidneys by mechanisms other than just blood pressure control. Currently, the ADA reco Continue reading >>

Utilization Of Angiotensin Converting Enzyme Inhibitors (acei) And Angiotensin Receptor Blockers (arb) In Patients Diagnosed With Diabetes: Analysis From The National Ambulatory Medical Care Survey

Utilization Of Angiotensin Converting Enzyme Inhibitors (acei) And Angiotensin Receptor Blockers (arb) In Patients Diagnosed With Diabetes: Analysis From The National Ambulatory Medical Care Survey

Utilization of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in patients diagnosed with diabetes: Analysis from the National Ambulatory Medical Care Survey Author links open overlay panel Sarai L.Ibrahim Assessed ACEI/ARB prescriptions in diabetic patients for ADA guideline adherence A low percentage of patients prescribed an ACEI/ARB (28.1% in 200732.2% in 2010) Females, age 1839, and Medicare users less likely to receive ACEI/ARB prescription Hypertension, hyperlipidemia and IHD: more likely to receive ACEI/ARB prescription Disparities in ACEI/ARB prescriptions remain evident The objective of this study was to determine if a difference exists in the proportion of visits for the prescribing of angiotensin converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARBs) in diabetic patients during 20072010. This retrospective, cross-sectional, observational study included adults diagnosed with diabetes mellitus from the National Ambulatory Medical Care Survey (NAMCS) during 20072010. Weighted chi-square tests and a multivariable logistic regression model were used to analyze associations between ACEI/ARB prescriptions and predictors of interest. Odds ratios and 95% confidence intervals were reported. An unweighted total of 13,590 outpatient ambulatory care visits were identified for adult patients with diabetes without contraindications to ACEIs or ARBs in the NAMCS for the years studied. No statistically significant increase in the proportion of visits with an ACEI/ARB prescription was identified for years 20072010 (28.1% in 2007 to 32.2% in 2010). Females (OR 0.78, 95% CI 0.69- 0.89), patients 1839 years old (OR 0.56, 95% CI 0.43- 0.75), and Medicare users (OR 0.81, 95% CI 0.70- 0.94) were significantly less likel Continue reading >>

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

Ace Inhibitors Improve Diabetic Nephropathy Through Suppression Of Renal Mcp-1

OBJECTIVE—Chemokines play an important role in the pathogenesis of diabetic nephropathy. Angiotensin II induces several fibrogenic chemokines, namely monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β. The progression of diabetic nephropathy can be retarded by ACE inhibitors (ACEIs) in patients with type 1 and type 2 diabetes. We examined if blockade of the renin-angiotensin system lowered urinary levels of the chemokine MCP-1 and correlated urinary MCP-1 (uMCP-1) with parameters of renal function and glucose and lipid metabolism before and after 1 year of treatment with an ACE inhibitor. RESEARCH DESIGN AND METHODS—In 22 patients with type 2 diabetes and diabetic nephropathy in stages 3–5, treatment with the ACEI lisinopril was initiated. Before treatment and after 12 months of continuous therapy, proteinuria, creatinine clearance, uMCP-1 levels, BMI, HbA1c, and serum cholesterol were assessed. RESULTS—Lisinopril treatment improved renal function. Proteinuria decreased from 410 ± 662 mg per 24 h to 270 ± 389 mg per 24 h. Creatinine clearance rose from 61 ± 26 to 77 ± 41 ml/min. Urinary MCP-1 levels decreased from 0.456 ± 0.22 ng/mg creatinine to 0.08 ± 0.096 ng/mg creatinine. The change in uMCP-1 correlated significantly (r = 0.61, P < 0.001) with the change in proteinuria. No other parameter correlated with the improvement in renal function. CONCLUSIONS—Blockade of the renin-angiotensin system in type 2 diabetic patients with diabetic nephropathy reduces uMCP-1 levels and improves renal function. Because MCP-1 induces monocyte immigration and differentiation to macrophages, which augment extracellular matrix production and tubulointerstitial fibrosis, pharmacological reduction of angiotensin II may also exert its beneficial ef Continue reading >>

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