Long-term effects of angiotensin-converting enzyme inhibition and metabolic control in hypertensive type 2 diabetic patients

Chan, Juliana C.N.; Ko, Gary T.C.; Leung, Denis H. Y.; Cheung, Robert C.K.; Cheung, Margaret Y.F.; So, Wing‐Yee; Swaminathan, R.; Nicholls, M. Gary; Critchley, J. A. J. H.; Cockram, Clive S.

doi:10.1046/j.1523-1755.2000.00879.x

Cited by 162 publications

(81 citation statements)

References 52 publications

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“…Thus, our findings challenge the current dogma of 'the higher HDL-C, the better the clinical outcomes'. In support of these 'paradoxical' findings, in a 3-year clinical trial comparing the effects of Enalapril and Nifedipine in hypertensive type 2 diabetic patients, high HDL-C was an independent predictor of declining GFR [28]. There are clinical and experimental evidence suggesting alterations in structure and function of HDL-C particles in the presence of albuminuria and renal dysfunction [29,30].…”

Section: Discussionmentioning

confidence: 98%

Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

Yang

et al. 2007

Diabetes Metabolism Res

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Section: Discussionmentioning

confidence: 98%

Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

Yang

et al. 2007

Diabetes Metabolism Res

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“…Diabetic patients are at risk of cardiovascular and atherosclerotic disease development and progression. Efforts should be made to reduce elevated blood pressure among diabetics with available medications, as tight blood pressure control have shown reductions in morbidity and mortality and diabetes related complications [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Additionally, diabetic patients should be screened for dyslipidemia as well, as this pathological state leads to CAD or IHD with high morbidity and mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Aziz¹

2017

Gen Med

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Dyslipidemia and hypertension alone predispose to the risk of coronary artery disease, especially if the patient is diabetic. This risk is increased and multiplied when both dyslipidemia and hypertension coexists. There is a lack of studies and significant data for the correlation or association of blood pressure with serum lipids. The studies conducted in the past showed the conflicting results with poor associations. Furthermore, these studies were not conducted on diabetic subjects and lack regression models or mathematical linear equations. Hence, we conducted a prospective, observational cohort study on 9340 diabetic subjects for the duration of 12 year (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), with the aim to find significant associations, correlations between serum lipids (total cholesterol, triglycerides, LDL-C, HDL-C and Non-HDL-C) and blood pressure (systolic and diastolic). Our data has demonstrated that total cholesterol, triglycerides, and LDL-C were significantly correlated with systolic and diastolic BP, and raised among hypertensive patients as compared to non-hypertensive ( p<0.001 for all lipids). The highest correlations were found between Non-HDL-C with systolic and diastolic blood pressures (r=0.414 and r=0.415, respectively with p<0.001). However, HDL-C was inversely correlated with systolic and diastolic BP and was raised among non-hypertensive patients. Regression models and mathematical linear equations were developed to estimate increasing blood pressure by the given serum lipid levels. All regression models were significant (p<0.0001). We concluded and developed regression models, for the first time in medical research that high lipid levels contribute to the development of increase systolic and diastolic blood pressures. With triglycerides, total-cholesterol, and HDL-C, Non-DHL-C levels should also be calculated in diabetology clinics and general practice. Screening should be done for diabetic patients to detect high blood pressure (or HTN) and elevated serum lipids, and early initiation of management to prevent diabetes complications.

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“…Several studies performed on normotensive, microalbuminuric patients with either type 1 or type 2 diabetes have shown that ACEI are very effective in reducing the incidence of overt proteinuria (secondary prevention) regardless of the BP levels (approximate risk reduction ratio [aRRR], 70% to 100%) (13-16). The MicroHOPE Study (17), which was performed on a large population, as well as two other smaller studies (18,19) confirm the efficacy of ACEI compared with other types of treatment in hypertensive, microalbuminuric, type 2 diabetic patients, in secondary prevention (aRRR, 23 to 68%). However, the same effect was not observed in two other studies (20,21).…”

Section: Renal Protectionmentioning

confidence: 92%

Optimizing Therapy in the Diabetic Patient with Renal Disease

Ravera¹,

Berruti²,

Leoncini³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Hypertension, impaired renal function, and proteinuria are commonly associated to the presence of diabetes. They play a major role in the development of cardiovascular and renal damage. Effective antihypertensive treatment reduces the progression of diabetic nephropathy and improves cardiovascular prognosis. Accordingly, tight BP control (Ͻ130/80 mmHg) is currently recommended in diabetic patients. Achieving BP targets represents the most important determinant of cardiovascular and renal protection. However, it has been suggested that specific classes of antihypertensive drugs may exert additional organ protection beyond their BP control. The pharmacologic blockade of the renin-angiotensin-aldosterone system has been shown to convey greater renal and cardiovascular protection compared with other classes of drugs. In particular, studies focusing on renal end point suggest that angiotensin-converting enzyme inhibitors (ACEI) are the firstchoice drugs in type 1 diabetes. Both ACEI and angiotensin II receptor blockers prevent the progression from microalbuminuria to clinical proteinuria in type 2 diabetes, but angiotensin blockers provide better renoprotection in patients with overt nephropathy. Regarding cardiovascular protection, several studies (but not all) have shown that ACEI exert a protective effect on diabetic patients. Recently, interesting results in favor of angiotensin receptor blockers have been reported in the IDNT, RENAAL, and LIFE studies. It should be noted that to achieve maximal renal and cardiovascular protection, most diabetic patients require integrated therapeutic intervention, including not only several antihypertensive drugs, but statins and antiplatelet therapy as well.Diabetes, hypertension, impaired renal function, and proteinuria are commonly associated conditions that act as a guilty company. They are, in fact, responsible for an increase in the risk of development and/or progression of cardiovascular disease, nephropathy, and retinopathy.Arterial BP plays a very important role in the development of renal damage and presents a complex relationship with diabetic nephropathy, with nephropathy raising BP, and with BP accelerating the course of nephropathy (1). Furthermore, as shown by epidemiologic studies, hypertension is responsible for increased cardiovascular morbidity and mortality associated with diabetes mellitus (1). Effective antihypertensive treatment reduces the risk of development and progression of nephropathy and, as is especially evident with angiotensinconverting enzyme (ACE) inhibitors (ACEI) and angiotensin receptor blockers (ARB), it lowers cardiovascular morbidity and mortality (2,3). Accordingly, current consensus groups have recommended tight BP control (Ͻ130/80 mmHg) in diabetic patients (2,4 -7).Proteinuria is considered a predictor of renal disease progression. Proteinuria acts on tubular cells by inducing inflammation and consequently interstitial fibrosis. In addition, proteinuria favors dyslipidemia, which aggravates renal damage and increases cardiov...

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Long-term effects of angiotensin-converting enzyme inhibition and metabolic control in hypertensive type 2 diabetic patients

Cited by 162 publications

References 52 publications

Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

Risk factors in V‐shaped risk associations with all‐cause mortality in type 2 diabetes—The Hong Kong Diabetes Registry

Association of Serum Lipids with High Blood Pressure and Hypertensionamong Diabetic Patients. Mathematical Regression Models to PredictBlood Pressure from Lipids. An Experience from 12-year Follow Up ofmore than 9000 Patients' Cohort

Optimizing Therapy in the Diabetic Patient with Renal Disease

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