The role of angiotensin II antagonism in type 2 diabetes mellitus: A review of renoprotection studies

Background: Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in Western and Asian countries. Effective antihypertensive therapy reduces the rate of decline in renal function and postpones ESRD in patients with diabetic nephropathy.Objective: This review presents evidence from studies on how blood pressure control, plasma glucose control, and the presence of proteinuria determine outcomes in diabetic patients. the role of angiotensin II (AII) in the development of diabetic nephropathy and the reno- and cardiobeneficial effects of All antagonism in patients with type 2 diabetes mellitus (DM-2) and diabetic nephropathy also are addressed.Methods: Articles included in this review were found using a MEDLINE search for studies published from 1991 to 2001 and including the search terms diabetic nephropathy, type 2 diabetes mellitus, microalbuminuria, proteinuria, angiotensin receptor blockade, angiotensin-converting enzyme inhibition, and cardiovascular disease. Articles reporting new data, new mechanisms, major clinical trials, and our own data were included.Results: Recently, the Reduction of Endpoints in NIDDM (non-insulin-dependent diabetes mellitus) with the Angiotensin II Antagonist Losartan (RENAAL) trial provided sufficient data to conclude that the blockade of the All AT1 receptor with losartan confers renoprotection in patients with DM-2 and nephropathy. Similar results were obtained with irbesartan in the Irbesartan Diabetic Nephropathy Trial (IDNT) and the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study (IRMA 2). the results of RENAAL indicate that the renoprotective effects of losartan were attributable to effects beyond blood pressure control. in addition to the favorable impact of the All blockade on blood pressure and renal hemodynamics, the blockade of the growth-promoting, profibrotic, nonhemodynamic actions of All also may be important for renoprotection. Intensive blood pressure control also confers cardiovascular protection in patients with DM-2. Some studies suggest that the blockade of the renin-angiotensin system confers superior cardioprotective effects in patients with DM-2. the RENAAL study also showed cardioprotection with losartan, with an important reduction in the risk for first hospitalization for heart failure.Conclusion: Evidence supports the importance of an effective blockade of All action for both reno- and cardioprotection in patients with DM-2.Universidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Endocrinol, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Endocrinol, BR-04038002 São Paulo, BrazilWeb of Scienc

Performance of Two Metabolic Syndrome Definitions in the Estimation of Cardiovascular Disease Among Hypertensive Patients

The authors evaluated the significance of metabolic syndrome (MetS) diagnosis, as defined by the National Cholesterol Education Program (NCEP) and by the International Diabetes Federation (IDF), in the evaluation of cardiovascular risk in hypertensive patients. Among 638 patients, the prevalence of MetS was 54.7% when the IDF criteria were used, compared with 45.5% when the NCEP criteria were used. MetS correlated significantly with the presence of cardiovascular disease (CVD). in patients without type 2 diabetes mellitus (T2DM), only MetS diagnosed using the IDF criteria was associated with the presence of CVD. in those with T2DM, MetS was not associated with CVD, regardless of the criteria used. the diagnosis of MetS, using either set of criteria, was associated with the development of T2DM. We conclude that, in hypertensive patients without diabetes, a diagnosis of MetS according to IDF criteria, but not the NCEP criteria, is useful in identifying individuals with a higher probability of incident CVD. in patients with diabetes, a population already considered at high risk for CVD, a diagnosis of MetS, regardless of the criteria used, has no further impact on prognosis.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Div Endocrinol, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Div Nephrol, São Paulo, BrazilWeb of Scienc

A neuroendocrine model of obesity worsen insulin resistance of spontaneously hypertensive rats: A new model of type 2 diabetes

Universidade Federal de São Paulo, Kidney & Hypertens Hosp, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Kidney & Hypertens Hosp, Div Nephrol, São Paulo, BrazilWeb of Scienc