Prevention of loss of renal function over time in patients with diabetic nephropathy

被引:49
作者
Barnett, A [1 ]
机构
[1] Univ Birmingham, Div Med Sci, Birmingham B9 5SS, W Midlands, England
[2] Birmingham Heartlands & Solihull Natl Hlth Serv T, Birmingham B9 5SS, W Midlands, England
关键词
angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; antihypertensive therapy; type 2 diabetes mellitus; diabetic nephropathy; telmisartan;
D O I
10.1016/j.amjmed.2006.01.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Management of hypertension is the mainstay of prevention and treatment of diabetic renal disease; evidence suggests that tight blood pressure control slows renal disease progression in established diabetic nephropathy. Inhibition of the renin-angiotensin-aldosterone system (RAAS) has renoprotective effects over and above those achieved by lowering systemic blood pressure. To date, however, no long-term study using hard end points has directly compared current mechanisms for RAAS inhibition, angiotensin II receptor blockade (ARB) and angiotensin-converting enzyme ( ACE) inhibition. This issue was addressed in the recently published Diabetics Exposed to Telmisartan and Enalapril ( DETAIL) study, a head-to-head comparison of telmisartan and enalapril in 250 patients with hypertension and type 2 diabetes mellitus and early-stage nephropathy. After 5 years' treatment, change in glomerular filtration rate (GFR), the primary efficacy end point, was equivalent in the 2 treatment groups, as were all secondary end points. The expected steep decline in GFR in the first year was followed by a lesser decrease in the second year and then almost complete stabilization of renal function at >= 3 years. Over 5 years, no patient went into end-stage renal disease or required dialysis. There were also no increases in albumin excretion rate, nor was there an increase in creatinine beyond 200 mu mol/L. Incidence of cardiovascular morbidity and mortality was extremely low in both treatment groups, a remarkable outcome given that almost 50% of patients had evidence of cardiovascular disease at randomization. Inhibition of the RAAS should play a major part in management of patients with type 2 diabetes with nephropathy, for which both telmisartan and enalapril provide long-term renoprotection. (C) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:40S / 47S
页数:8
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