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Published in: Drugs 14/2002

01-10-2002 | Leading Article

The Role of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists in the Management of Diabetic Complications

Authors: Toomas Podar, Professor Jaakko Tuomilehto

Published in: Drugs | Issue 14/2002

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Abstract

Evidence suggests that ACE inhibitors can be advantageous for prevention and halting progression of both micro- and macrovascular complications in patients with diabetes mellitus. ACE inhibitors are useful antihypertensive agents in both type 1 and type 2 diabetes; however, ACE inhibitor therapy often needs to be supplemented with calcium channel antagonists, β-blockers or diuretics to achieve good blood pressure control. ACE inhibitors are also indicated in non- hypertensive patients with type 1 and type 2 diabetes who have micro- or macroalbuminuria. The effect of ACE inhibitors in halting the development and progression of retinopathy and, potentially, neuropathy needs further proof in large-scale studies. More recently, angiotensin II receptor antagonists are emerging as drugs with the potential to be successfully included in the management of diabetic complications, especially when ACE inhibitors are not suitable because of adverse effects.
Literature
1.
go back to reference NHBPE Program. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994; 23: 145–60CrossRef NHBPE Program. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994; 23: 145–60CrossRef
2.
go back to reference Joint National Committee on Prevention, Detection, Evaluation, et al. The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–46CrossRef Joint National Committee on Prevention, Detection, Evaluation, et al. The sixth report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–46CrossRef
3.
go back to reference Sowers JR. Comorbidity of hypertension and diabetes: the fosinopril versus amlodipine cardiovascular events trial (FACET). Am J Cardiol 1998; 82: 15R-9RCrossRef Sowers JR. Comorbidity of hypertension and diabetes: the fosinopril versus amlodipine cardiovascular events trial (FACET). Am J Cardiol 1998; 82: 15R-9RCrossRef
4.
go back to reference Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000; 36: 646–61 Bakris GL, Williams M, Dworkin L, et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 2000; 36: 646–61
5.
go back to reference UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13CrossRef UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13CrossRef
6.
go back to reference UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–20CrossRef UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–20CrossRef
7.
go back to reference Lindholm L, Hansson L, Ekbom T, et al. Comparison of anti-hypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish trial in old patients with hypertension-2. STOP Hypertension-2 Study Group. J Hypertens 2000; 18: 1671–5 Lindholm L, Hansson L, Ekbom T, et al. Comparison of anti-hypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish trial in old patients with hypertension-2. STOP Hypertension-2 Study Group. J Hypertens 2000; 18: 1671–5
8.
go back to reference Tuomilehto J, Rastenyte D, Birkenhänger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999; 340: 677–84PubMedCrossRef Tuomilehto J, Rastenyte D, Birkenhänger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999; 340: 677–84PubMedCrossRef
9.
go back to reference Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–9CrossRef Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253–9CrossRef
10.
go back to reference Bosch J, Yusuf S, Pogue J, et al. Use of ramipril in preventing stroke: double blind randomised trial. BMJ 2002; 324: 699PubMedCrossRef Bosch J, Yusuf S, Pogue J, et al. Use of ramipril in preventing stroke: double blind randomised trial. BMJ 2002; 324: 699PubMedCrossRef
11.
go back to reference Hansson L, Lindholm L, Niskanen L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999; 353: 611–6PubMedCrossRef Hansson L, Lindholm L, Niskanen L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999; 353: 611–6PubMedCrossRef
12.
go back to reference Niskanen L, Hedner T, Hansson L, et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ace inhibitor compared with a diuretic/[beta]-blocker-based treatment regimen: a subanalysis of the captopril prevention project. Diabetes Care 2001; 12: 2091–6CrossRef Niskanen L, Hedner T, Hansson L, et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy with an ace inhibitor compared with a diuretic/[beta]-blocker-based treatment regimen: a subanalysis of the captopril prevention project. Diabetes Care 2001; 12: 2091–6CrossRef
13.
go back to reference Chantrel F, Moulin B, Hannedouche T. Blood pressure, diabetes and diabetic nephropathy. Diabetes Metab 2000; 26 Suppl. 4: 37–44 Chantrel F, Moulin B, Hannedouche T. Blood pressure, diabetes and diabetic nephropathy. Diabetes Metab 2000; 26 Suppl. 4: 37–44
14.
go back to reference Parving HH, Andersen AR, Smidt UM, et al. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1983; I: 1175–9CrossRef Parving HH, Andersen AR, Smidt UM, et al. Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy. Lancet 1983; I: 1175–9CrossRef
15.
go back to reference Mathiesen ER, Hommel E, Giese J, et al. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 1991; 303: 81–7PubMedCrossRef Mathiesen ER, Hommel E, Giese J, et al. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ 1991; 303: 81–7PubMedCrossRef
16.
go back to reference The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 1997; 349: 1787–92CrossRef The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 1997; 349: 1787–92CrossRef
17.
go back to reference Lewis E, Hunsicker L, Bain R, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993; 329: 1456–62 Lewis E, Hunsicker L, Bain R, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993; 329: 1456–62
18.
go back to reference Mogensen CE, Neldam S, Tikkanen I, et al. for the CALM study group. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000; 321: 1440–4 Mogensen CE, Neldam S, Tikkanen I, et al. for the CALM study group. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000; 321: 1440–4
19.
go back to reference Estacio RO, Jeffers BW, Hiatt WR, et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338: 645–52PubMedCrossRef Estacio RO, Jeffers BW, Hiatt WR, et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338: 645–52PubMedCrossRef
20.
go back to reference Estacio RO, Jeffers BW, Gifford N, et al. Effect of blood pressure control on diabetic microvascular complications on patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23 Suppl. 2: B54–64PubMed Estacio RO, Jeffers BW, Gifford N, et al. Effect of blood pressure control on diabetic microvascular complications on patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23 Suppl. 2: B54–64PubMed
21.
go back to reference Schrier RW, Estacio RO, Esler A, et al. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 2002; 61: 1086–97PubMedCrossRef Schrier RW, Estacio RO, Esler A, et al. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 2002; 61: 1086–97PubMedCrossRef
22.
go back to reference Ravid M, Brosh D, Levi Z, et al. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med 1998; 128: 982–8PubMed Ravid M, Brosh D, Levi Z, et al. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med 1998; 128: 982–8PubMed
23.
go back to reference Golan L, Birkmeyer JD, Welch HG. The cost-effectiveness of treating all patients with type 2 diabetes with angiotensin-converting enzyme inhibitors. Ann Intern Med 1999; 131: 660–7PubMed Golan L, Birkmeyer JD, Welch HG. The cost-effectiveness of treating all patients with type 2 diabetes with angiotensin-converting enzyme inhibitors. Ann Intern Med 1999; 131: 660–7PubMed
24.
go back to reference Leehey D, Singh A, Alavi N, et al. Role of angiotensin II in diabetic nephropathy. Kidney Int 2000; 58 Suppl. 77: S93–8CrossRef Leehey D, Singh A, Alavi N, et al. Role of angiotensin II in diabetic nephropathy. Kidney Int 2000; 58 Suppl. 77: S93–8CrossRef
25.
go back to reference Lewis E, Hunsicker L, Clarke W, 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: 851–60PubMedCrossRef Lewis E, Hunsicker L, Clarke W, 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: 851–60PubMedCrossRef
26.
go back to reference Parving H, Lehnert H, Brochner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–8PubMedCrossRef Parving H, Lehnert H, Brochner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–8PubMedCrossRef
27.
go back to reference Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 1004–10PubMedCrossRef Lindholm LH, Ibsen H, Dahlof B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 1004–10PubMedCrossRef
28.
go back to reference Larsen M, Hommel E, Parving HH, et al. Protective effect of captopril on the blood-retina barrier in normotensive insulin-dependent diabetic patients with nephropathy and background retinopathy. Graefes Arch Clin Exp Ophthalmol 1990; 228: 505–9PubMedCrossRef Larsen M, Hommel E, Parving HH, et al. Protective effect of captopril on the blood-retina barrier in normotensive insulin-dependent diabetic patients with nephropathy and background retinopathy. Graefes Arch Clin Exp Ophthalmol 1990; 228: 505–9PubMedCrossRef
29.
go back to reference Chaturvedi N, Sjolie AK, Stephenson JM, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EU- RODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus. Lancet 1998; 351: 28–31 Chaturvedi N, Sjolie AK, Stephenson JM, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EU- RODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus. Lancet 1998; 351: 28–31
30.
go back to reference Caldwell P, Seegal B, Hsu K, et al. Angiotensin converting enzyme, vascular endothelial localization. Science 1976; 191: 1050–1PubMedCrossRef Caldwell P, Seegal B, Hsu K, et al. Angiotensin converting enzyme, vascular endothelial localization. Science 1976; 191: 1050–1PubMedCrossRef
32.
go back to reference Cameron NE, Cotter MA, Robertson S. Rapid reversal of a motor nerve conduction deficit in streptozotocin-diabetic rats by the angiotensin converting enzyme inhibitor lisinopril. Acta Diabetol 1993; 30: 46–8PubMedCrossRef Cameron NE, Cotter MA, Robertson S. Rapid reversal of a motor nerve conduction deficit in streptozotocin-diabetic rats by the angiotensin converting enzyme inhibitor lisinopril. Acta Diabetol 1993; 30: 46–8PubMedCrossRef
33.
go back to reference Cameron NE, Cotter MA, Robertson S. Angiotensin converting enzyme inhibition prevents development of muscle and nerve dysfunction and stimulates angiogenesis in streptozotocin-diabetic rats. Diabetologia 1992; 35: 12–8PubMedCrossRef Cameron NE, Cotter MA, Robertson S. Angiotensin converting enzyme inhibition prevents development of muscle and nerve dysfunction and stimulates angiogenesis in streptozotocin-diabetic rats. Diabetologia 1992; 35: 12–8PubMedCrossRef
34.
go back to reference Reja A, Tesfaye S, Harris ND, et al. Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabet Med 1995; 12: 307–9PubMedCrossRef Reja A, Tesfaye S, Harris ND, et al. Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabet Med 1995; 12: 307–9PubMedCrossRef
35.
go back to reference Kontopoulos AG, Athyros VG, Didangelos TP, et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997; 20: 355–61PubMedCrossRef Kontopoulos AG, Athyros VG, Didangelos TP, et al. Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 1997; 20: 355–61PubMedCrossRef
36.
go back to reference Malik RA, Williamson S, Abbott C, et al. Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998; 352: 1978–81PubMedCrossRef Malik RA, Williamson S, Abbott C, et al. Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998; 352: 1978–81PubMedCrossRef
37.
go back to reference Hoogwerf BJ, Young JB. The HOPE study: ramipril lowered cardiovascular risk, but vitamin E did not. Cleve Clin J Med 2000; 67: 287–93PubMed Hoogwerf BJ, Young JB. The HOPE study: ramipril lowered cardiovascular risk, but vitamin E did not. Cleve Clin J Med 2000; 67: 287–93PubMed
38.
go back to reference Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the losartan intervention for end-point reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003PubMedCrossRef Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the losartan intervention for end-point reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003PubMedCrossRef
Metadata
Title
The Role of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists in the Management of Diabetic Complications
Authors
Toomas Podar
Professor Jaakko Tuomilehto
Publication date
01-10-2002
Publisher
Springer International Publishing
Published in
Drugs / Issue 14/2002
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/00003495-200262140-00001

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