The Role of Angiotensin II Receptor Antagonists in the Management of Diabetes

Author: Barnett, Anthony H.

Source: Blood Pressure, Volume 10, Supplement 1, 20 February 2001 , pp. 21-26(6)

Publisher: Informa Healthcare

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Diabetic nephropathy, which develops in about 30% of patients with diabetes, is a progressive condition. It is characterized by increased blood pressure, declining glomerular filtration rate and albuminuria. Lowering of blood pressure in diabetic patients is associated with reduced cardiovascular risk and renal protection. Inhibitors of angiotensin-converting enzyme (ACE) are the current gold standard treatment for hypertension in patients with type I diabetes because, in addition to their blood pressure lowering ability, they are thought to oppose the increased intraglomerular pressure that is mediated in part by angiotensin II. The angiotensin II receptor antagonists, a more recently developed class of antihypertensive agents, appear to be as effective as ACE inhibitors in delaying the progression of renal injury in animal models of diabetes. They act by selectively blocking the binding of angiotensin II to the AT1 receptor and may, therefore, offer a more complete blockade of the renin-angiotensin system than ACE inhibitors. The renal and antihypertensive effects of this class of drug in patients with diabetes are now being investigated in long-term clinical trials. The multicentre Diabetics Exposed to Telmisartan And EnalaprIL (DETAIL) study is a randomized, double-blind, parallel-group comparison of the renal and antihypertensive effects of the angiotensin II receptor antagonist telmisartan and the ACE inhibitor enalapril in 272 patients with type II diabetes. The primary outcome is change in glomerular filtration rate over the 5 years of the study.


Document Type: Regular Paper


Affiliations: Birmingham Heartlands Hospital, Birmingham, UK

Publication date: February 20, 2001

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