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Angiotensin Receptor Blockade Improves Renal Blood Flow in Diabetics

Mar 1, 2005

Chronic angiotensin II receptor blockade with olmesartan improves renal vascular perfusion despite significant blood pressure reductions in patients with type 2 diabetes.

Dr. Danilo Fliser from Medical School Hannover stated that, "Angiotensin II subtype 1 receptor antagonists (AT1-RA) not only lower blood pressure, but at the same time lower intraglomerular pressure and increase renal perfusion." "Thus, their use offers a complete prevention of hemodynamically mediated damage to the diabetic kidney."

Dr. Fliser and colleagues examined the effect of 12 weeks of treatment with the AT1-RA olmesartan on renal hemodynamics in 35 patients with type 2 diabetes.

Blood pressure fell significantly with olmesartan treatment, the authors report, but did not change significantly in patients that received placebo.

Olmesartan treatment was associated with a significant increase in effective renal plasma flow and decreases in filtration fraction and renal vascular resistance, but glomerular filtration rate did not change with AT1-RA blockade. In contrast, patients that received placebo experienced a significant increase in filtration fraction and a nonsignificant increase in renal vascular resistance.
Reductions in isoprostane generation in the patients treated with olmesartan suggest that chronic AT1-RA blockade may prevent renal vascular damage not only by direct hemodynamic effects but also by reducing inflammation and/or reactive oxygen species generation, the investigators explain.

"Our results document that the favorable renal hemodynamic action of AT1-RA observed in acute experiments in individuals with type 2 diabetes persists even after prolonged AT1-receptor blockade," the authors conclude. "This effect may contribute to the renoprotective effect of AT1-RA documented in large prospective trials on prevention of progression of diabetic nephropathy."

Dr. Fliser added that "our findings support the routine use of AT1-RA, at least in diabetic patients with hypertension and/or presence of renal involvement."
J Am Soc Nephrol 2005


In patients with type 2 diabetes, treatment with lipid-lowering agents reduces cardiovascular risk. "Most patients, including those whose baseline LDL cholesterol levels are below 115 mg/dL, and possibly below 100 mg/dL, benefit from statins. Moderate doses of these drugs suffice in most patients with diabetes."
Ann Intern Med. 2004;140:644-649, 650-658