The increased activity of the renin-angiotensin-aldosterone system (RAAS) is an important pathogenetic factor in the development of nephropathy in diabetic patients. The damaging factor of this system is the end-product, angiotensin IIand the damaging effects are vasoconstriction, increase of aldosterone secretion, growth, fibrosis, thrombosis, inflammation and oxidation. Theoretically, on this basis, blockade of the RAAS should have a beneficial effect on the development of diabetic nephropathy. The main goal in the treatment of diabetic nephropathy is control of the glycaemic status and aggressive antihypertensive therapy, primarily with RAAS-blocking agents. It was demonstrated recently that angiotensin II receptor blockers (ARBs) have a slowing effect on the progression of diabetic nephropathy (RENAAL and IDNT trials) or on the development of proteinuria (IRMA) in type 2 diabetes. These effects are specific and independent of the decrease in blood pressure. Theoretically, the combination of an angiotensin-converting enzyme inhibitor (ACEI) and an ARB can lead to a more complete blockade of the RAAS. A new study (ONTARGET) has now started to investigate whether treatment with a combination of an ACEI and an ARB has a more potent beneficial effect on the cardiovascular events and the nephropathy in type 2 diabetic patients as compared with separate treatment with the two agents.
机构:
Univ Alberta, Royal Alexandra Hosp, Mat Management Ctr, Chair Obes Res & Management, Edmonton, AB T5H 3V9, CanadaUniv Alberta, Royal Alexandra Hosp, Mat Management Ctr, Chair Obes Res & Management, Edmonton, AB T5H 3V9, Canada
Sharma, Arya M.
Weir, Matthew R.
论文数: 0引用数: 0
h-index: 0
机构:
Univ Maryland, Sch Med, Dept Med, Div Nephrol, Baltimore, MD 21201 USAUniv Alberta, Royal Alexandra Hosp, Mat Management Ctr, Chair Obes Res & Management, Edmonton, AB T5H 3V9, Canada
机构:
Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, 02115, MADepartment of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, 02115, MA
Price D.A.
Hollenberg N.K.
论文数: 0引用数: 0
h-index: 0
机构:
Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, 02115, MADepartment of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, 02115, MA