Skip to main content
SpringerLink
Log in

Diabetic Renal and Related Heart Disease

ACE Inhibitors and/or Angiotensin Receptor Blockers: Does It Matter?

  • Chapter
The Diabetic Kidney

Part of the book series: Contemporary Diabetes ((CDI))

  • 1326 Accesses

Abstract

Several factors are important in determining the rate of progression of diabetic renal disease always starting from microalbuminuria (1), and elevated blood pressure (BP) seems to be a major factor, both in types 1 and 2 diabetes (1–3). This was confirmed in a new analysis in the follow-up studies of proteinuric patients conducted by Steno Diabetes Center (2,3). Although the prognosis for diabetic nephropathy has improved in the last two decades, it is clear that proteinuric patients still have a poor prognosis (1). For type 1 diabetes, this analysis (2) showed that elevated BP, glycemic control, and albuminuria were major factors in the progression. Serum cholesterol level also seemed to play some role. The rate of progression in patients with albuminuria and type 2 diabetes is quite similar (3), although it should be noted that patients with type 2 diabetes and proteinuria most often die from cardiovascular (CV) disease before progression to end-stage renal disease (ESRD), even more than patients with type 1 diabetes and albuminuria.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mogensen CE. Microalbuminuria and hypertension with focus on type 1 and type 2 diabetes. JIM 2003;254:45–66.

    Article  CAS  Google Scholar 

  2. Hovind P, Rossing P, Tarnow L, Smidt UM, Parving HH. Progression of diabetic nephropathy. Kidney Int 2001;59:702–709.

    Article  PubMed  CAS  Google Scholar 

  3. Rossing K, Christensen PK, Hovind P, Tarnow L, Rossing P, Parving HH. Progression of nephropathy in type 2 diabetic patients. Kidney Int 2004;66:1596–1605.

    Article  PubMed  Google Scholar 

  4. Wolf G, Ritz E. Combination therapy with ACE inhibitors and angiotensin II receptor blockers to halt progression of chronic renal disease: pathophysiology and indications. Kidney Int 2005;67:799–812.

    Article  PubMed  CAS  Google Scholar 

  5. 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 randomized controlled study. Diabetes Med 2004;21:471–475.

    Article  CAS  Google Scholar 

  6. ACE Inhibitors in Diabetic Nephropathy Trialist Group. Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting-enzyme inhibitors? A meta-analysis of individual patient data. Ann Intern Med 2001;134:370–379.

    Google Scholar 

  7. Christensen CK, Mogensen CE. Effect of Antihypertensive Treatment on Progression of Incipient Diabetic Nephropathy. Hypertension 1985;7(6 Part 2):II109–II113.

    PubMed  CAS  Google Scholar 

  8. Opie LH, Schall R. Old antihypertensives and new diabetes. J Hypertens 2004;22:1453–1458.

    Article  PubMed  CAS  Google Scholar 

  9. Scheen AJ. Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 1. A metaanalysis of randomised clinical trials. Diabetes Metab 2004;30:487–496.

    Article  PubMed  CAS  Google Scholar 

  10. Scheen AJ. Renin-angiotensin system inhibition prevents type 2 diabetes mellitus. Part 2. Overview of physiological and biochemical mechanisms. Diabetes Metab 2004;39:498–505.

    Article  Google Scholar 

  11. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022–2031.

    Article  PubMed  CAS  Google Scholar 

  12. Ravid M, Brosh D, Levi Z, Bar-Dayan Y, Ravid D, Rachmani R. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuri patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998;128:982–988.

    PubMed  CAS  Google Scholar 

  13. Kvetny J, Gregersen G, Pedersen RS. Randomized Placebo-controlled trial of perindopril in normotensive, normoalbuminuric patients with type 1 diabetes mellitus. QJM 2001;94(2):89–94.

    Article  PubMed  CAS  Google Scholar 

  14. Ruggenenti P, Fassi A, Ilieva AP, et al. Preventing Microalbuminuria in Type 2 Diabetes. NEJM 2004;351(19);1941–1951.

    Article  PubMed  CAS  Google Scholar 

  15. Adler AI, Stevens RJ, Manley SE, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study. Kidney Int 2003;63:225–232.

    Article  PubMed  Google Scholar 

  16. Gæde P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:383–393.

    Article  PubMed  Google Scholar 

  17. Mauer M, Zinman B, Gardiner R, et al. ACE-I and ARBs in early diabetic nephropathy. J Renin Angiotensin Aldosterone Syst 2002;3:262–269.

    Article  PubMed  CAS  Google Scholar 

  18. On behalf of the Family Investigation of Nephropathy and Diabetes Research Group. The Family Investigation of Nephropathy and Diabetes (FIND) Design and methods. J Diabetes Complications 2005;19:1–9.

    Article  Google Scholar 

  19. Barnett AH, Bain SC, Bouter P, et al. Angiotensin-Receptor Blockade versus Converting-Enzyme Inhibition in Type 2 Diabetes and Nephropathy. N Engl J Med 2004;351:1952–1961.

    Article  PubMed  CAS  Google Scholar 

  20. Lacourciére Y, Bélanger A, Godin C, et al. Long-term comparison of losartan and enalapril on kidney function in hypertensive Type 2 diabetics with early nephropathy. Kidney Int 2000;58:762–769.

    Article  PubMed  Google Scholar 

  21. Muirhead N, Feagan BF, Mahon J, et al. The effects of valsartan and captopril on reducing microalbuminuria in patients with Type 2 Diabetes Mellitus: a placebo-controlled trial. Curr Therapeutic Res 1999;60:650–660.

    Article  CAS  Google Scholar 

  22. Mogensen CE, Neldam S, Tikkanen I, et al. Randomised controlled trial of dual blockade of reninangiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000;321:1440–1444.

    Article  PubMed  CAS  Google Scholar 

  23. Andersen NH, Poulsen PL, Knudsen ST, et al. Long-term dual blockade with candesartan and lisinopril in hypertensive patients with diabetes mellitus. The CALM II Study. Diabetes Care 2005;48:273–277.

    Article  Google Scholar 

  24. 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;345:861–869.

    Article  PubMed  CAS  Google Scholar 

  25. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851–860.

    Article  PubMed  CAS  Google Scholar 

  26. Strippoli GFM, Craig M, Deeks JJ, Schena FP, Craig JC. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ 2004;329(7470):1–12.

    Article  Google Scholar 

  27. So WY, Ozaki R, Chan NN, et al. Effect of Angiotensin-converting Enzyme inhibition on Survival in 3773 Chinese Type 2 Diabetic Patients. Hypertension 2004;44:294–299.

    Article  PubMed  CAS  Google Scholar 

  28. Nakao N, Yoshimura A, Morita H, Takada M, Kayano T, Ideura T. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet 2003:361:177–224.

    Google Scholar 

  29. Strippoli GFM, Jonathan CC. Combined treatment with angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers to prevent end-stage kidney disease in patients who do not have diabetes. Med J Aust 2004;181:450, 451.

    PubMed  Google Scholar 

  30. Izzo JL, Weinberg MS, Hainer JW, et al. Antihypertensive Efficacy of Candesartan-Lisinopril in Combination of Lisinopril: The AMAZE Trials. J Clin Hypertens 2004;6(9):485–493.

    Article  CAS  Google Scholar 

  31. Fujisawa T, Ikegami H, Ono M, et al. Combination of Half Doses of Angiotensin Type 1 Receptor Antagonisk and Angiotensin-Converting Enzyme Inhibitor in Diabetic Nephropathy. Am J Hypertens 2005;18:13–17.

    Article  PubMed  CAS  Google Scholar 

  32. Asgari AA, Sarvghadi F, Zahed N. Telmisartan vs. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):835.

    Article  PubMed  Google Scholar 

  33. Parving H-H, Hovind P, Rossing P. Telmisartan vs. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):835.

    Article  PubMed  CAS  Google Scholar 

  34. Loewenstein JE. Telmisartan vs. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):836.

    Google Scholar 

  35. Bain SC, Barnett A. Telmisartan vs. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):836.

    CAS  Google Scholar 

  36. Zandi-Nejad K, Brenner BM. Preventing Microalbuminuria in Type 2 Diabetes. Telmisartan vs. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):833.

    Article  PubMed  CAS  Google Scholar 

  37. Mauer M, Fioretto P. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):834.

    Google Scholar 

  38. Ruggenenti P, Perna A, Remuzzi G. Enalapril in Type 2 Diabetes. N Engl J Med 2005;352(8):834.

    CAS  Google Scholar 

  39. Cohn JN, Tognoni G: A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345:1667–1675.

    Article  PubMed  CAS  Google Scholar 

  40. Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309–1321.

    Article  PubMed  CAS  Google Scholar 

  41. Koji T, Onishi K, Dohi K, et al. Addition of Angiotensin II Receptor Antagonist to an ACE Inhibitor in Heart Failure Improves Cardiovascular Function by a Bradykinin-Mediated Mechanism. J Cardiovasc Pharmacol 2003;41:632–639.

    Article  PubMed  CAS  Google Scholar 

  42. Nakamura Y, Yoshiyama M, Omura T, et al. Beneficial effects of combination of ACE inhibitor and angiotensin II type 1 receptor blocker on cardiac remodeling in rat myocardial infarction. Cardiovasc Res 2003;57:48–54.

    Article  PubMed  CAS  Google Scholar 

  43. Krombach RS, Clair MJ, Hendrick JW, et al. Angiotensin converting enzyme inhibition, AT1 receptor inhibition, and combination therapy with pacing induced heart failure: effects on left ventricular performance and regional blood flow patterns. Cardiovasc Res 1998;38:631–645.

    Article  PubMed  CAS  Google Scholar 

  44. Baruch L, Anand I, Cohen IS, Ziesche S, Judd D, Cohn JN: Augmented short-and long-term hemodynamic and hormonal effects of an angiotensin receptor blocker added to angiotensin converting enzyme inhibitor therapy in patients with heart failure. Vasodilator Heart Failure Trial (V-HeFT) Study Group. Circulation 1999;99:2658–2664.

    PubMed  CAS  Google Scholar 

  45. Hamroff G, Katz SD, Mancini D, et al. Addition of angiotensin II receptor blockade to maximal angiotensin-converting enzyme inhibition improves exercise capacity in patients with severe congestive heart failure. Circulation 1999;99:990–992.

    PubMed  CAS  Google Scholar 

  46. McKelvie RS, Yusuf S, Pericak D, et al. Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999;100:1056–1064.

    PubMed  CAS  Google Scholar 

  47. McMurray JJ, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:767–771.

    Article  PubMed  CAS  Google Scholar 

  48. Ryden L, Armstrong PW, Cleland JG, et al. Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial. Eur Heart J 2000;21:1967–1978.

    Article  PubMed  CAS  Google Scholar 

  49. Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003;349:1893–1906.

    Article  PubMed  CAS  Google Scholar 

  50. Yusuf S. From the HOPE to the ONTARGET and the TRANSCEND studies: challenges in improving prognosis. Am J Cardiol 2002;89:18A–25A.

    Article  PubMed  Google Scholar 

  51. Verma S, Strauss M: Angiotensin receptor blockers and myocardial infarction. BMJ 2004;329:1248–1249.

    Article  PubMed  Google Scholar 

  52. Julius S, Kjeldsen SE, Weber M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022–2031.

    Article  PubMed  CAS  Google Scholar 

  53. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial. Lancet 2003;362:777–781.

    Article  PubMed  CAS  Google Scholar 

  54. Granger CB, McMurray JJ, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003;362:772–776.

    Article  PubMed  CAS  Google Scholar 

  55. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 1991;325:293–302.

    Google Scholar 

  56. Kjoller-Hansen L, Steffensen R, Grande P. The angiotensin-converting enzyme inhibition post revascularization study (APRES). J Am Coll Cardiol 2000;35:881–888.

    Article  PubMed  CAS  Google Scholar 

  57. Dagenais GR, Yusuf S, Bourassa MG, et al. Effects of ramipril on coronary events in high-risk persons: results of the heart outcomes prevention evaluation study. Circulation 104:522–526, 2001.

    Google Scholar 

  58. Hoving P, Tarnow L, Rossing P, Carstensen B, Parving HH. Improved survival in patients obtaining remission of nephrotic range albuminuria in diabetic nephropathy.“ Kidney Int 2004;66:1180–1186.

    Article  Google Scholar 

  59. Hovind P, Rossing P, Tarnow L, Toft H, Parving J, Parving HH. Remission of nephrotic-range albuminuria in type 1 diabetic patients. Diabetes Care 2001;24:1972–1977.

    Article  PubMed  CAS  Google Scholar 

  60. Mogensen CE, Poulsen PL. Microalbuminuria, glycemic control, and blood pressure predicting outcome in diabetes type 1 and type 2. Kidney Int 2004;66(S92):S40, S41.

    Article  Google Scholar 

  61. de Zeeuw D, Remuzzi G, Parving HH, et al. Proteinuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004;110:921–927.

    Article  PubMed  CAS  Google Scholar 

  62. Yuyun MF, Dinnesen SF, Edwards OM, Wood E, Wareham NJ. Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy. Diabet Med 2003;20:277–282.

    Article  PubMed  CAS  Google Scholar 

  63. Spoelstra-de Man AM, Brouwer CB, Stehouwer CD, Smulders YM. Rapid progression of albumin excretion is an independent predictor of cardiovascular mortality in patients with type 2 diabetes and microalbuminuria. Diabetes Care 2001;24:2097–2101.

    Article  Google Scholar 

  64. Ibsen H, Olsen MH, Wachtell K, et al. Does albuminuria predict cardiovascular outcomes on treatment with losartan versus atenolol in patients with diabetes, hypertension, and left vendtricular hypertrophy? Diabetes Care, In press.

    Google Scholar 

  65. Gaede P, Tarnow L, Vedel P, Parving HH, Pedersen O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant 2004;19(11):2784–2788.

    Article  PubMed  Google Scholar 

  66. Abraira C, Duchworth W, McCarren M, et al. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2 Veterans Affairs Diabetes Trial. J Diabetes Complications 2003;17:314–322.

    Article  PubMed  Google Scholar 

  67. American Diabetes Association: Clinical Practice Redommendations 2005. Diabetes Care 2005;28(S1).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine M (Diabetes and Endocrinology), Aarhus University Hospital, Aarhus, Denmark

    Carl Erik Mogensen MD & Niels Holmark Andersen MD, PhD

Authors
  1. Carl Erik Mogensen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niels Holmark Andersen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Medicine, Henry Ford Hospital, Detroit, MI

    Pedro Cortes MD

  2. Department of Internal Medicine M (Diabetes and Endocrinology), Aarhus University Hospital, Aarhus, Denmark

    Carl Erik Mogensen MD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Mogensen, C.E., Andersen, N.H. (2006). Diabetic Renal and Related Heart Disease. In: Cortes, P., Mogensen, C.E. (eds) The Diabetic Kidney. Contemporary Diabetes. Humana Press. https://doi.org/10.1007/978-1-59745-153-6_25

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-153-6_25

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-624-5

  • Online ISBN: 978-1-59745-153-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation