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Benefits of renin angiotensin system inhibitors in hypertensive patients with diabetes mellitus

Medicina interna
Articol din publicatia Timisoara Medical Journal nr. 4/2004
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Romulus Timar, Viorel Serban, Laura Diaconu, Adrian Vlad

Department of Diabetes and Metabolic Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara
Correspondence to:
Romulus Timar, Diabetes Clinic, 156 I. Bulbuca Str., 1900 Timisoara,
Tel: 0722608268, Email: timarrz@yahoo.com


Hypertension is an extremely common diabetes comorbidity, affecting approximately 20 to 60% of diabetic patients. Hypertension further increases the risk for both micro- and macrovascular complications in diabetes. Activation of the renin-angiotensin system (RAS) plays an important role in the pathogenesis of hypertension, atherosclerosis, heart failure, diabetic and hypertensive nephropathy. Angiotensin II (AT II), the active component of RAS, has a negative impact on micro- and macroangiopathy not only through elevating blood pressure but through several additional mechanisms (stimulation of leukocytes recruitment, macrofages activation, proliferation of endothelial cells, hypertrophy and migration of smooth muscle cells, collagen deposition in the vascular wall, thrombosis). Several long-term randomized controlled trials have demonstrated the efficacy of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in lowering high blood pressure, reducing cardiovascular morbidity and mortality, total mortality and microvascular complications in diabetic patients. Some of these studies have suggested that RAS inhibitors may have additional beneficial effects independent of the blood pressure lowering action. These evidences justify the use of ACEIs as the first-line hypotensive agents in diabetic patients with mild or more severe hypertension, with or without nephropathy. In type 2 diabetic patients with diabetic nephropathy, ARBs have been shown to have considerable renoprotective effects. In these patients, in the presence of macroalbumunuria (albuminuria > 300mg/day) or renal insufficiency, ARBs should be strongly considered. Key Words: hypertension, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, renin angiotensin system, cardiovascular disease, diabetic nephropathy