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

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dc.contributor.author Zanella, M. T.
dc.contributor.author Ribeiro, A. B.
dc.date.accessioned 2016-01-24T12:33:26Z
dc.date.available 2016-01-24T12:33:26Z
dc.date.issued 2002-07-01
dc.identifier http://dx.doi.org/10.1016/S0149-2918(02)80016-9
dc.identifier.citation Clinical Therapeutics. New York: Excerpta Medica Inc, v. 24, n. 7, p. 1019-1034, 2002.
dc.identifier.issn 0149-2918
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/26911
dc.description.abstract 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. en
dc.format.extent 1019-1034
dc.language.iso eng
dc.publisher Excerpta Medica Inc
dc.relation.ispartof Clinical Therapeutics
dc.rights Acesso restrito
dc.subject angiotensin II antagonists en
dc.subject diabetic nephropathy en
dc.subject microalbuminuria en
dc.subject type 2 diabetes mellitus en
dc.subject proteinuria en
dc.subject cardioprotection en
dc.subject renoprotection en
dc.title The role of angiotensin II antagonism in type 2 diabetes mellitus: A review of renoprotection studies en
dc.type Resenha
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.description.affiliation Universidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Endocrinol, BR-04038002 São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Nephrol, BR-04038002 São Paulo, Brazil
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Hosp Rim & Hipertensao, Div Endocrinol, BR-04038002 São Paulo, Brazil
dc.identifier.doi 10.1016/S0149-2918(02)80016-9
dc.description.source Web of Science
dc.identifier.wos WOS:000177296500001



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