Preventing microalbuminuria in type 2 diabetes

Ruggenenti, Piero; Fassi, Anna; A, Ilieva

doi:10.1016/j.accreview.2004.12.120

Cited by 139 publications

(187 citation statements)

References 19 publications

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“…26 The design of BP-lowering RCTs comparing calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers with placebo (with tested drugs and placebo often being added on a background of pre-existing antihypertensive therapy) was such that smaller SBP/ DBP differences were achieved. Nonetheless, evidence of significant reductions of stroke, major cardiovascular events, and cardiovascular and all-cause deaths by 10 RCTs (30 359 patients) comparing calcium antagonists with placebo 28,32,35,41,54,55,66,70,85,90 ( Figure 3D), evidence of significant reductions of stroke, CHD, HF, and major cardiovascular events by 12 RCTs (35 707 patients) using angiotensin-converting enzyme inhibitors 32,42,48,66,73,76,77,79,81,83,88,92 ( Figure 3E), and evidence of significant reductions in stroke, HF, and major cardiovascular events by 13 RCTs (65 256 patients) using angiotensin receptor blockers 49,75,80,82,[85][86][87]89,91,[93][94][95][96] ( Figure 3F) were obtained. 26 Among calcium antagonist RCTs, it was possible to separately analyze, in a sensitivity meta-analysis, 4 RCTs 35,41,54,55 enrolling exclusively hypertensive patients without or with mini...…”

Section: Effects Of Bp Lowering Produced By Drugs Belonging To Differmentioning

confidence: 99%

“…Forty-seven trials (153 825 participants) 2,8,9, were of intentional BP lowering, and 21 (92 060 participants) were classified as nonintentional BP-lowering trials (Table). In the primary analysis, restricted to the 47 intentional BPlowering RCTs, all considered outcomes were significantly reduced by BP lowering, 23 with the risk of stroke and HF being reduced to the greatest extent (36% and 43%, respectively, for a standardized SBP/DBP difference between active and In all RCTs in which randomization was to >2 groups, comparisons are between the average of all treatment groups and placebo 32,44,45,57,77,78,85 or between combination therapy and average of monotherapies. 66 In HOT 50 comparison is between groups randomized to DBP target <80 vs DBP targets <85 and <90 mm Hg together.…”

Section: Effects Of Bp Lowering On Outcome Incidence In Hypertensionmentioning

confidence: 99%

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Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Zanchetti

Thomopoulos

Parati

2015

Circulation Research

148

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Sixty-eight blood pressure (BP)-lowering randomized controlled trials (defined as randomized controlled trials comparing active treatment with placebo, or less active treatment, achieving a BP difference, performed between 1966 and end 2013 in cohorts with ≥40% hypertensive patients, and exclusive of trials in acute myocardial infarction, heart failure, acute stroke, and dialysis) were identified and meta-analyzed grouping the randomized controlled trials on the basis of clinically relevant questions: (1) does BP lowering reduce all types of cardiovascular outcome? (2) Is prevention of all outcomes proportional to the extent of systolic, diastolic, and pulse BP? (3) Have all classes of BP-lowering drugs been shown capable of reducing all types of cardiovascular outcome? (4) Is BP lowering beneficial when intervention is initiated at any grade (or stage) of hypertension? (5) Do BP-lowering randomized controlled trials provide evidence about systolic BP and diastolic BP targets of treatment? (6) Should BP-lowering treatment be preferentially addressed to patients in higher risk categories promising larger absolute treatment benefits? The results of these meta-analyses provide further support to current hypertension treatment guidelines by showing that BP lowering can significantly reduce major cardiovascular outcomes largely independent of the agents used, significant risk reduction is found at all hypertension grades (stages), and when systolic BP is lowered below a cut off of 140 mm Hg with some further reduction limited to stroke at systolic BP values just <130 mm Hg. Absolute risk reduction progressively increases higher is total cardiovascular risk, but this greater benefit is associated with a progressively higher residual risk, ie, higher treatment failures. (Circ Res.

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Section: Effects Of Bp Lowering Produced By Drugs Belonging To Differmentioning

confidence: 99%

Section: Effects Of Bp Lowering On Outcome Incidence In Hypertensionmentioning

confidence: 99%

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Zanchetti

Thomopoulos

Parati

2015

Circulation Research

148

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“…In the EUCLID study, for example, the ACEI treatment results in the normotensive normoalbuminuric subset of patients with type 1 diabetes was not significant (Table 1) [46]. The first strong evidence that ACEIs could reduce the risk of de novo onset of microalbuminuria emerged from the BENEDICT, a multicenter, double-blind, placebo-controlled randomized study that addressed the issue of primary prevention by comparing the effects of the ACEI trandolapril in combination with the nondihydropyridine calcium channel blocker verapamil, trandolapril alone, verapamil alone, and placebo on the incidence of microalbuminuria in type 2 diabetes, hypertension, and normoalbuminuria [47]. The target blood pressure was 120/80 mm Hg.…”

Section: Treatmentmentioning

confidence: 99%

The Goal of Blood Pressure Control for Prevention of Early Diabetic Microvascular Complications

Williams

2011

Curr Diab Rep

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Lowering blood pressure may confer a benefit to diabetic microvascular complications comparable with glycemic control. Hypertension is causally related to kidney outcomes and is a risk factor for the development of diabetic retinopathy. The prevalence of hypertension increases as kidney disease progresses, so that it coexists with diabetes in up to 80% of those with overt nephropathy. A significant number of patients have hypertension or rising blood pressures in earlier stages, or even before microvascular complications appear. Because microalbuminuria markedly increases the risk of overt nephropathy as well as of cardiovascular complications, primary prevention (i.e., preventing or delaying the onset of microalbuminuria) continues to be explored, predominantly through use of renin-angiotensin blockade. Available data reviewed suggest that primary prevention through blood pressure reduction is more likely to benefit select groups (those with hypertension, cardiovascular risks, or old age). This review discusses the relationship between hypertension, diabetes, and kidney disease, the rationale for primary prevention, and the data that led to that conclusion.

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“…Five randomised controlled trials have compared ACE inhibitors with calcium-channel blockers in patients with type 2 diabetes and hypertension 24–28…”

Section: Diabetic Kidney Diseasementioning

confidence: 99%

“…The first study randomised 1,204 patients with type 2 diabetes and hypertension, but normal urinary albumin excretion, to treatment for a median of 3.6 years with trandolapril 2mg daily; verapamil 240mg daily; both drugs (trandolapril 2mg daily plus verapamil 180mg daily); or placebo (blinding status of trial not stated) 24. Trandolapril plus verapamil reduced blood pressure from 151/87mmHg to 139/80mmHg and trandolapril alone from 151/87mmHg to 139/81mmHg.…”

Section: Diabetic Kidney Diseasementioning

confidence: 99%

Hypertension in type 2 diabetes - targeting angiotensin

2005

DTB

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Cardiovascular disease accounts for around 60% of deaths in people with type 2 diabetes mellitus, and diabetes is the leading cause of renal dysfunction and premature death in the UK.1,2 A key factor in these outcomes is that many people with type 2 diabetes also have raised blood pressure, which increases the likelihood of vascular complications.3–5 Lowering elevated blood pressure, using one or more antihypertensive drugs, reduces illness and mortality rates in such people.6,7 National guidelines advocate the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists in selected patients with type 2 diabetes.3,8,9 Here we review whether such treatment offers advantages over other antihypertensive drugs.

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Preventing microalbuminuria in type 2 diabetes

Cited by 139 publications

References 19 publications

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

Randomized Controlled Trials of Blood Pressure Lowering in Hypertension

The Goal of Blood Pressure Control for Prevention of Early Diabetic Microvascular Complications

Hypertension in type 2 diabetes - targeting angiotensin

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