Item #4
Smoking
Increases Risk of Diabetic Nephropathy Despite ACE Inhibition
Cigarette
smoking increases oxidant stress and thereby progressive renal injury
in patients with type 2 diabetes.
In
type 2 diabetics being treated with ACE inhibitors, cigarette smoking
and increased urine albumin excretion (UAE) are linked as predictors
of nephropathy progression, researchers at Texas Tech University have
determined
The
findings are reported in the American Journal of Kidney Diseases for
January. Senior
researcher Dr. Donald E. Wesson said, “that the study suggests that
cigarette smoking increases the risk for a diabetic to develop kidney
failure.” He noted that
ACE inhibition "successfully prevents kidney failure in most
nonsmoking diabetics."
Dr.
Wesson and colleagues prospectively followed 84 hypertensive patients
with type 2 diabetes--31 cigarette smokers and 53 nonsmokers--whose
hypertension was treated with an ACE inhibitor-containing regimen.
At
study entry, the mean albumin-creatinine (alb-cr) ratio did not differ
between smokers and nonsmokers, but over an average of 64 months of
follow-up, the mean increase was significantly greater in smokers than
in smokers.
The
rate of progression was low and fairly stable when the entry alb-cr
ratio was <300, and it increased markedly as the ratio increased
over that value. Smoking predicted progression in the subgroup of
patients with greater UAE (alb-cr ratio >300).
Furthermore,
the increase in the alb-cr ratio correlated well with progression to
nephropathy, the Texas team calculated.
"The
present studies are consistent with the hypothesis that cigarette
smoking increases oxidant stress and thereby progressive renal injury
in patients with type 2 diabetes that is manifest by increased
UAE," the researchers conclude.
Am
J Kidney Dis 2003;41:13-21.
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DID
YOU KNOW:
Which
Is More Important: Systolic
Hypertension or Diastolic Hypertension?
Physicians
assumed that diastolic hypertension was more serious than systolic
hypertension. But, some
30 years ago most felt that
elevated systolic blood pressure would seem to play more of a role in
the development of left ventricular hypertrophy and stroke than high
diastolic blood pressure. Now there is considerable evidence to
support the concept that systolic hypertension is a good predictor of
future cardiovascular disease. In
a recent issue of Archives of Internal Medicine,[1]
reported that the control of systolic blood pressure was more
important than the control of diastolic blood pressure in hypertensive
men. They further stated that diastolic blood pressure was of little
value in predicting future cardiovascular risk.
Benetos
A, Thomas F, Bean K, Gautier S, Smulyan H, Guize L. Prognostic value
of systolic and diastolic blood pressure in treated hypertensive men.
Arch Intern Med. 2002;162:577-581.
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