Role of angiotensin receptor blockers in diabetes: Implications of recent clinical trials

Expert Review of Cardiovascular Therapy

Volumn 7, Issue 11, 2009, Pages 1363-1371

  McFarlane, Samy I ^a  

^a STATE UNIVERSITY OF NEW YORK   (United States)

Author keywords

Ontarget; Target organ protection; Telmisartan

Indexed keywords

AMLODIPINE; ANGIOTENSIN RECEPTOR ANTAGONIST; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; IRBESARTAN; LOSARTAN; NATEGLINIDE; PLACEBO; RAMIPRIL; TELMISARTAN; VALSARTAN;

ALBUMINURIA; ANKLE EDEMA; BLOOD PRESSURE REGULATION; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; CAUSE OF DEATH; CEREBROVASCULAR ACCIDENT; CLINICAL TRIAL; COMORBIDITY; DIABETIC NEPHROPATHY; DIASTOLIC BLOOD PRESSURE; DISEASE COURSE; DRUG DOSE INCREASE; DRUG DOSE TITRATION; DRUG EFFECT; DRUG RESPONSE; DRUG TOLERABILITY; GLOMERULUS FILTRATION RATE; GLUCOSE METABOLISM; HEART FAILURE; HEART INFARCTION; HEART PROTECTION; HIGH RISK PATIENT; HUMAN; HYPERTENSION; INSULIN SENSITIVITY; KIDNEY BLOOD FLOW; KIDNEY FAILURE; LOW DRUG DOSE; MONOTHERAPY; MORTALITY; NON INSULIN DEPENDENT DIABETES MELLITUS; PROTEINURIA; RENAL PROTECTION; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; REVIEW; RISK REDUCTION; SYSTOLIC BLOOD PRESSURE; UNSPECIFIED SIDE EFFECT;

ANGIOTENSIN II TYPE 1 RECEPTOR BLOCKERS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CLINICAL TRIALS AS TOPIC; DIABETES MELLITUS, TYPE 2; HUMANS; HYPERTENSION;

EID: 73349101547     PISSN: 14779072     EISSN: 17448344     Source Type: Journal    
DOI: 10.1586/erc.09.115     Document Type: Review

References (25)

1. Rosamond W, Flegal K, Furie K et al; The American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart and Stroke Statistics - 2008 Update. Circulation 117, E25-E146 (2008).
2. Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR; UKPDS group. Development and progression of nephropathy in Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 63, 225-232 (2003).
3. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16, 434-444 (1993).
4. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes: UKPDS 38. BMJ 317, 703-713 (1998).
5. Ong KL, Cheung BM, Wong LY, Wat NM, Tan KC, Lam KS. Prevalence, treatment, and control of diagnosed diabetes in the US National Health and Nutrition Examination Survey 1999-2004. Ann. Epidemiol. 18, 222-229 (2008).
6. McFarlane SI, Jacober SJ, Winer N et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. Diabetes Care 25, 718-723 (2002).
7. McFarlane SI, Castro J, Kaur J et al. Control of blood pressure and other cardiovascular risk factors at different practice settings: outcomes of care provided to diabetic women compared to men. J. Clin. Hypertens. (Greenwich) 7, 73-80 (2005).
8. 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 MICROHOPE substudy. Lancet 355(9200), 253-259 (2000).
9. Daly CA, Fox KM, Remme WJ, Bertrand ME, Ferrari R, Simoons ML; EUROPA Investigators. The effect of perindopril on cardiovascular morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy. Eur. Heart J. 26, 1369-1378 (2005).
10. McFarlane SI, Kumar A, Sowers JR. Mechanisms by which angiotensin-converting enzyme inhibitors prevent diabetes and cardiovascular disease. Am. J. Cardiol. 91, H30-H37 (2003).
11. Brenner BM, Cooper ME, de Zeeuw D et al. Effects of losartan on renal and cardiovascular outcomes in patients with Type 2 diabetes and nephropathy. Massachusetts Med. Soc. 345, 861-869 (2001).
12. Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensinreceptor antagonist irbersartan in patients with nephropathy due to Type 2 diabetes. N. Engl. J. Med. 345, 851-860 (2001).
13. Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P; Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with Type 2 diabetes. N. Engl. J. Med. 345, 870-878 (2001).
14. Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM. Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and Type 2 diabetes. Diabetes Care 30, 1351-1356 (2007). • Multicenter, randomized, controlled study used renal plasma flow in response to NG-monomethyl-l-arginine (l-NMMA), which is a measure of nitric oxide activity to assess vascular function. A total of 9 weeks of treatment with telmisartan or ramipril significantly increased renal plasma flow.
15. Gerstein HC, Mann JF, Yi Q et al; HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286, 421-426 (2001).
16. Zanchetti A, Julius S, Kjeldsen S et al. Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial. J. Hypertens. 24, 2163-2168 (2006).
17. Mann JF, Schmieder RE, McQueen M et al; ONTARGET Investigators. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372, 547-553 (2008). •• Monotherapy with either telmisartan or ramipril significantly reduced the risk of renal outcomes in patients at high vascular risk.
18. Barnett AH, Bain SC, Bouter P et al; Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in Type 2 diabetes and nephropathy. N. Engl. J. Med. 351, 1952-1961 (2004).
19. Galle J, Schwedhelm E, Pinnetti S, Böger RH, Wanner C; VIVALDI Investigators. Antiproteinuric effects of angiotensin receptor blockers: telmisartan versus valsartan in hypertensive patients with Type 2 diabetes mellitus and overt nephropathy. Nephrol. Dial. Transplant. 23, 3174-3183 (2008).
20. Bakris G, Burgess E, Weir M, Davidai G, Koval S. Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int. 74, 364-369 (2008). •• Results suggest that telmisartan may have greater vasculoprotective effects than the less lipophilic losartan.
21. Viberti G, Wheeldon NM; Microalbuminuria Reduction with Valsartan (MARVAL) Study Investigators. Microalbuminuria reduction with valsartan in patients with Type 2 diabetes mellitus: a blood pressure-independent effect. Circulation 106, 672-678 (2002).
22. Hollenberg NK, Parving HH, Viberti G et al. Albuminuria response to very high-dose valsartan in Type 2 diabetes mellitus. J. Hypertens. 25, 1921-1926 (2007). • In patients with diabetes, higher doses of valsartan (320 or 640 mg) are required to reduce albuminuria than to control blood pressure.
23. Estacio RO, Coll JR, Tran ZV, Schrier RW. Effect of intensive blood pressure control with valsartan on urinary albumin excretion in normotensive patients with Type 2 diabetes. Am. J. Hypertens. 19, 1241-1248 (2006).
24. Andraws R and Brown DL. Effect of inhibition of the renin-angiotensin system on development of Type 2 diabetes mellitus (meta-analysis of randomized trials). Am. J. Cardiol. 99, 1006-1012 (2007). • Meta-analysis of data from 13 trials involving 93,451 patients found that the odds of developing diabetes was reduced by 26% (odds ratio: 0.74; 95% CI: 0.66-0.81, p < 0.001) with renin-angiotensin-aldeosterone inhibition compared with no treatment. angiotensinconverting enzyme inhibitors and angiotensin receptor blockers had similar effects.
25. Takai S, Kirimura K, Jin D et al. Significance of angiotensin II receptor blocker lipophilicities and their protective effect against vascular remodeling. Hypertens. Res. 28, 593-600 (2005). •• In an animal model, highly lipophilic telmisartan had a significantly greater positive effect on endothelial function than losartan, an angiotensin receptor blocker with very low lipophilicity.