Losartan in patients with type 2 diabetes and proteinuria: Observations from the RENAAL Study

Shahinfar, Shahnaz; Dickson, Tania Z.; Ahmed, Tultul; Zhang, Zhonxin; Ramjit, Denise; Smith, Ronald D.; Brenner, Barry M.

doi:10.1046/j.1523-1755.62.s82.13.x

Cited by 28 publications

(27 citation statements)

References 14 publications

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“…In addition, losartan therapy significantly improved the abnormalities of platelet activation markers and soluble cell adhesion molecules in hypertensive patients with diabetes (Table 3). These findings suggest that losartan may reduce the risk of renal and cardiovascular complications in hypertensive diabetics, and are in agreement with other recent reports about this drug [35][36][37]. ARB may have beneficial effects on the vascular system beyond their antihypertensive action [20][21][22][23][38][39][40].…”

Section: Discussionsupporting

confidence: 92%

Losartan and Simvastatin Inhibit Platelet Activation in Hypertensive Patients

Nomura

Shouzu

Omoto

et al. 2004

J Thromb Thrombolysis

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Section: Discussionsupporting

confidence: 92%

Losartan and Simvastatin Inhibit Platelet Activation in Hypertensive Patients

Nomura

Shouzu

Omoto

et al. 2004

J Thromb Thrombolysis

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“…The BENEDICT study demonstrated that blockade of the renin-angiotensin system (RAS) with the ACEi trandolapril prevented the progression to microalbuminuria in hypertensive, type 2 diabetic patients with a normal urinary albumin excretion rate [59]. While a reduction in proteinuria or albuminuria is an important finding, the use of surrogate markers to determine the efficacy of a medication should be cautioned, as the reduction in proteinuria achieved with losartan in the Reduction of Endpoints in NIDDM with the AIIA Losartan (RENAAL) study accounted for only $50% of the treatment effect of losartan on the risk reduction for ESRD [60]. As such, ESRD should be an important focus of renal studies examining pharmacologic efficacy, rather than surrogate markers such as reduction of proteinuria [60].…”

Section: Aiias and Diabetic Nephropathymentioning

confidence: 99%

Blockade of the renin–angiotensin–aldosterone system: a key therapeutic strategy to reduce renal and cardiovascular events in patients with diabetes

Burnier

Zanchi

2006

Journal of Hypertension

103

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Diabetes (particularly type 2 diabetes) represents a global health problem of epidemic proportions. Individuals with diabetes are not only more likely to develop hypertension, dyslipidemia, and obesity, but are also at a significantly higher risk for coronary heart disease, peripheral vascular disease, and stroke. Angiotensin II plays a key pathophysiological role in the progression of diabetic renal disease, and blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II antagonists has therefore become an important therapeutic strategy to reduce renal and cardiovascular events in patients with diabetes. Several studies have demonstrated the effects of angiotensin II antagonists on the reduction of albuminuria and the progression of renal disease from microalbuminuria to macroalbuminuria. More importantly, several endpoint trials have shown that the antiproteinuric effects of losartan and irbesartan translate into cardiovascular and renoprotective benefits beyond blood pressure lowering, thereby delaying the need for dialysis or kidney transplantation by several years. These and other studies indicate that angiotensin II antagonists not only improve survival and quality of life of patients with diabetic nephropathy, but also have the potential to reduce the substantial healthcare burden associated with managing these patients. ACEi also appear to exert similar beneficial effects in diabetic patients, but whether clinically significant differences in renoprotection or mortality exist between angiotensin II antagonists and ACEi in patients with type 2 diabetes remains to be fully investigated in appropriate head-to-head studies.

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“…[1][2][3][4][5][6] An increase in albuminuria is associated with higher cardiovascular morbidity and mortality, 7 whereas a decrease achieved through drug therapy is associated with better outcomes. 8 Albuminuria is prevalent in older and middle-aged people with type 2 diabetes mellitus, 9 -11 in whom cardiovascular and renal complication rates are the highest. [12][13][14] Thus, it is of particular importance to identify predictors of worsening albuminuria in older people with diabetes mellitus.…”

mentioning

confidence: 99%

Telemedicine Home Blood Pressure Measurements and Progression of Albuminuria in Elderly People With Diabetes

et al. 2008

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Abstract-We assessed whether home blood pressure monitoring improved the prediction of progression of albuminuria when added to office measurements and compared it with ambulatory blood pressure monitoring in a multiethnic cohort of older people (nϭ392) with diabetes mellitus, without macroalbuminuria, participating in the telemedicine arm of the Informatics for Diabetes Education and Telemedicine Study. Albuminuria was assessed by measuring the spot urine albumin:creatinine ratio at baseline and annually for 3 years. The ambulatory sleep:wake systolic blood pressure ratio was categorized as dipping (ratio: Յ0.9), nondipping (ratio: Ͼ0.9 to 1.0), and nocturnal rise (ratio: Ͼ1.0). In a repeated-measures mixed linear model, after adjustment that included office pulse pressure, home pulse pressure was independently associated with a higher follow-up albumin:creatinine ratio (Pϭ0.001). That association persisted (Pϭ0.01) after adjusting for 24-hour pulse pressure and nocturnal rise, which were also independent predictors (Pϭ0.02 and Pϭ0.03, respectively). Cox proportional hazards models examined the progression of albuminuria (nϭ74) as defined by cutoff values used by clinicians. After the adjustment for office pulse pressure, the hazards ratio (95% CI) per 10-mm Hg increment of home pulse pressure was 1.34 (range: 1.1 to 1.7; Pϭ0.01). Home pulse pressure was not an independent predictor in the model including ambulatory monitoring data; a nocturnal rise was the only independent predictor (Pϭ0.035). Cox models built separately for home pulse pressure and ambulatory monitoring exhibited similar calibration and discrimination. In conclusion, nocturnal blood pressure elevation was the strongest predictor of worsening albuminuria. Home blood pressure measurements added to office measurements and may constitute an adequate substitute for ambulatory monitoring. Key Words: albuminuria Ⅲ diabetes mellitus Ⅲ home blood pressure Ⅲ ambulatory blood pressure A lbuminuria is independently associated with cardiovascular morbidity and mortality in people with and without diabetes mellitus. [1][2][3][4][5][6] An increase in albuminuria is associated with higher cardiovascular morbidity and mortality, 7 whereas a decrease achieved through drug therapy is associated with better outcomes. 8 Albuminuria is prevalent in older and middle-aged people with type 2 diabetes mellitus, 9 -11 in whom cardiovascular and renal complication rates are the highest. 12-14 Thus, it is of particular importance to identify predictors of worsening albuminuria in older people with diabetes mellitus.Ambulatory blood pressure monitoring (ABPM) predicts progression of albuminuria better than office blood pressure (BP) in people with diabetes, [15][16][17][18][19] and 24-hour pulse pressure (PP) and a nocturnal increase in BP are the most informative variables in elderly diabetic subjects. 18,19 However, ABPM is not yet considered the standard of care for the management of hypertension. On the other hand, a growing number of patients are successfully monitori...

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Losartan in patients with type 2 diabetes and proteinuria: Observations from the RENAAL Study

Cited by 28 publications

References 14 publications

Losartan and Simvastatin Inhibit Platelet Activation in Hypertensive Patients

Losartan and Simvastatin Inhibit Platelet Activation in Hypertensive Patients

Blockade of the renin–angiotensin–aldosterone system: a key therapeutic strategy to reduce renal and cardiovascular events in patients with diabetes

Telemedicine Home Blood Pressure Measurements and Progression of Albuminuria in Elderly People With Diabetes

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