|
Item
#13
Why
ACE inhibitors Remain Central to Management of Type 2 Diabetes
In
addition to hypoglycemia and antihypertensive
agents—particularly ACE inhibitors—-play a central role in
the management of type 2 diabetes.
As
a recent review of the subject points out, ACE inhibitors have
earned this status not only because of their demonstrated potent
antihypertensive properties but also because of reported
protective effects on the kidney and heart, and to a lesser
extent, on the eye and peripheral nerves. Moreover,
cost-effectiveness studies indicate that these drugs provide such
benefits at considerable indirect costs.
The
reviewers noted that the best clinical evidence of ACE Inhibitor
nephro-protection is exemplified by a 1993 report from the
Cooperative Study Group showing that captopril reduced the risk of
death, dialysis, or renal transplantation by 80%, compared with
placebo, and more recently by the MICRO-HOPE Investigators, who
reported a 24% reduction in the risk of overt nephropathy with
ramipril, also compared with placebo, in addition, the 1999
DIAB1OPSIES study showed that proteinuna increased in patients
given a placebo but decreased In those treated with perindopril;
morphometric analysis revealed that cortical interstitial
fractional volume Increased significantly in the placebo group but
remain unchanged in the perlndopril group.
ACE
inhibitors, the reviewers pointed out, have not only markedly
reduced the cardiovascular mortality in patients with diabetes but
also reduced the incidence of heart failure and other cardiac
events—with the same or better efficacy. Compared with
beta-blockers or diuretics, and sometimes with better compliance.
In the HOPE data, ramipril treatment was shown to reduce the risks
of myocardial infarction, stroke, cardiovascular death, and
coronary revascularization by 22%, 33%. 37%, and 17%,
respectively. These risk reductions were not accounted for by the
2 to 3 mm Hg fall in blood pressure produced by ramipril.
As
for the eye, progression of diabetic retinopathy in the EUCLID
study (1997) was slowed by 50% in lisinopril-treated patients
compared with placebo-treated patients, and MICRO-HOPE data showed
a 16% reduction in the likelihood of laser therapy in
ramipril-treated patients, even though the study was not designed
to examine retinopathy.
Finally,
improved nerve conduction velocity was noted in one 1996 study
after 12 weeks of lisinopril therapy and after 12 months of trandolapril
therapy In a 1995 study.
The
reviewers noted that continued improvements in the use or ACE
inhibitors will require studies involving various unexamined
issues, includiung comparison of results in patients with the same
risk factors, particularly hereditary cardiovascular risk factors,
and head-to-head comparisons of different ACE inhibitors and of
ACE inhibitors and other agents, such as angiotensin II receptor
blockers.
Cordonniar
DJ et el. Role of ACE
inhibitors in patients with diabetes. Drugs.
2001;C1:1883-1892,
================================
DID
YOU KNOW:
A
clove of garlic each day may lower total cholesterol by as much as
9% and be part of, but not a substitute for, a meal plan low in
saturated fat.
================================
Back / Next Item
[an error occurred while processing this directive]
|
