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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension frequently accompanies diabetes mellitus, as it is present in 50% of diabetic patients. Hypertension can sometimes preceed diabetes. In type 2 diabetes, insulin resistance plays a major role in the hypertensive risk. In type 1 diabetes, nephropathy is often noted as soon as hypertension is present. Both hypertension and diabetes increase the risk for cardiovascular and renal complications. For their prevention, first of all, modification of the diet with increasing exercise must be proposed, associated to antihypertensive agents with a blood pressure target lower than 130/80 mmHg. Renin-angiotensin blockers constitute the main drug therapy in such patients associated with diuretics or betablocker if angina pectoris is present or even calcium channel blocker when large arteries abnormalities exist. A frequent evaluation of the cardiovascular risk is required together with research of renal dysfunction or microproteinuria.
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PMID:[Hypertension and diabetes]. 1604 61

Diabetic nephropathy is a major cause of diabetes- related morbidity and mortality; however the clinical course of the disease and the renal prognosis is highly variable among individuals. The current review will discuss the genetic influence on the development of end stage renal disease (ESRD) in diabetic patients and potential improvements to the current treatment strategy to slow the loss of kidney function in these patients. In this first part, the growing evidence that glucose-induced activation of the intra-renal and systemic renin-angiotensin systems plays an essential role in processes leading to destruction of renal function is summarised. Genetic variations, especially the angiotensin-converting enzyme (ACE)/ID polymorphisms in the gene coding for ACE, are involved in activation of the renin-angiotensin system and seem to influence the clinical course of diabetic nephropathy during treatment with ACE inhibitors. In addition, this polymorphism may interact with other polymorphisms within the renin-angiotensin system, leading to high risk of ESRD. As new genetic approaches and methods develop, further understanding of diabetic nephropathy will evolve and genotyping will help prevent ESRD in diabetic patients.
J Renin Angiotensin Aldosterone Syst 2005 Mar
PMID:Preventing end stage renal disease in diabetic patients--genetic aspect (part I). 1608 46

Renin-angiotensin system blockade has been shown to be superior to other antihypertensive therapy in slowing progression of renal disease in diabetic patients, but questions remain regarding diabetic retinopathy. The primary objective of the DIabetic REtinopathy Candesartan Trials (DIRECT) Programme is to examine primary (incidence) and secondary (progression) prevention of diabetic retinopathy when blocking angiotensin II type 1-receptors with candesartan in normoalbuminuric, normotensive Type 1 diabetic patients, and secondary prevention only in normoalbuminuric, normotensive or treated hypertensive Type 2 diabetic patients. The secondary objectives include examining the effect of candesartan treatment on urinary albumin excretion rate (UAER) in each of the three studies and to examine the incidence of proliferative retinopathy in all three populations combined. Standardised investigations for patients at enrolment include blood pressure measurement, analysis of HbA1C and serum lipids, and a detailed ophthalmological examination. Retinopathy and UAER outcomes are assessed yearly. Retinopathy is graded centrally, based on seven-field stereo photographs using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Randomisation was performed when the results of retinal gradings were available, and treatment with 16 mg candesartan cilexetil or matching placebo was initiated; the dose was increased to 32 mg after one month. Calculations of UAER are based on two timed overnight urine collections. A sample size re-assessment was carried out when approximately 70% of the patients had been randomised in the DIRECT Programme to ensure the results to be conclusive. In total, 5,231 patients were randomised in the DIRECT Programme in 30 countries. One thousand, four hundred and twenty one and 1,905 patients are evaluated in the primary and secondary prevention studies in Type 1 diabetes, respectively and 1,905 patients in the secondary prevention study in Type 2 diabetes. HbA1C showed mean values of 8.1, 8.5 and 8.2% for the Type 1 primary, Type 1 secondary and Type 2 secondary prevention studies, respectively. In the Type 1 secondary prevention study, 49% of the patients had mild nonproliferative retinopathy (level 20) in at least one eye, and 9% had moderate-moderately severe non-proliferative retinopathy (level 43-47). In Type 2 patients, 17% had level 43-47 and the remainder less severe retinopathy.
J Renin Angiotensin Aldosterone Syst 2005 Mar
PMID:The DIabetic REtinopathy Candesartan Trials (DIRECT) Programme: baseline characteristics. 1608 48

Diabetic nephropathy is a major cause of diabetes related morbidity and mortality. The first part of the current review was published in the last issue of this journal and discussed the important role of the renin-angiotensin system (RAS) in diabetic nephropathy and the genetic influence on development of endstage renal disease (ESRD) in diabetic patients. This second part of the review focus on the potential improvement of the current treatment strategy to slow down the loss of kidney function using dual blockade of the RAS with both ACE-inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs). Substantial evidence from short-term studies using surrogate endpoints indicates a beneficial impact of dual blockade of the RAS, not obtainable with single agent blockade alone, both in diabetic and non-diabetic renal disease. This conclusion has been confirmed and extended in a longterm trial with regard to prevention of ESRD in non-diabetic renal disease. Results indicate that dual blockade of the RAS may further slow down, but not arrest progressive loss of renal function. However, studies defining the optimal dose of ACE-I / ARBs without additional adverse effects are essential to ensure relevant comparison with dual blockade therapy. Trials using primary renal endpoints in diabetic nephropathy are still needed, and will finally establish the role of dual blockade of the RAS in a clinical setting.
J Renin Angiotensin Aldosterone Syst 2005 Sep
PMID:Preventing end-stage renal disease in diabetic patients - dual blockade of the renin-angiotensin system (Part II). 1647 Apr 84

Activation of the renin-angiotensin system (RAS) in diabetes is thought to contribute to nephropathy. This is suggested by findings of an enhanced renovascular (RPF) response to RAS blockade with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs). An alternative approach to assess RAS activation is the evaluation of renin release following RAS blockade. Forty-four consecutively enrolled Type 1 diabetic patients (28.2+/-1.5 years) and 37 normal subjects (37+/-2.6 years) in high salt balance were given 25 mg of captopril and 16 mg of candesartan p.o. on consecutive days. All subjects were Caucasian. All, except one diabetic patient, had normal renal function. Plasma renin activity (PRA) and renal plasma flow (RPF) were measured for four hours after both drugs, and at eight, and 24 hours after candesartan. As anticipated, both drugs increased PRA. Peak responses (90' after captopril) were 5.6+/-1 ng/mL Ang I/hour in diabetic patients, and 1.7+/-0.9 ng/mL Ang I/hour in normal subjects (p<0.001). Responses to both drugs were correlated in diabetic patients for PRA (r=0.623; p=0.001) and for RPF (r=0.9; p<0.001). When the PRA response to captopril was below the median, the RPF response was limited (22.1+/-17.6 ml/minute/1.73 m2). When it was above the median, the RPF response was also larger (62.2+/-13.9 ml/minute/1.73 m2; p=0.006). Renin response to ACE-I and ARB confirms activation of the RAS in diabetic patients.
J Renin Angiotensin Aldosterone Syst 2005 Sep
PMID:Renin release in response to Renin system blockade: activation of the Renin system in type 1 diabetes mellitus. 1647 Apr 86

Targeting the renin-angiotensin-aldosterone system (RAAS), specifically the effector peptide angiotensin II (Ang II), represents a major opportunity for slowing the progression of cardiovascular disease (CVD) and, in turn, reducing the risk of morbidity and mortality. Inhibition of angiotensin-converting enzyme (ACE) and selective blockade of Ang II AT1 receptors are two approaches through which the pathophysiological effects of Ang II can be targeted. Numerous clinical studies have established the benefits of ACE inhibitors (ACE-Is) in lessening the morbidity and mortality burden of CVD. There are, however, tolerability concerns associated with ACE-Is, such as angioedema and dry cough. By blocking Ang II at the AT1 receptor level, Ang II receptor blockers (ARBs) provide a more specific and complete blockade of the deleterious effects of Ang II and tend to have more favourable tolerability. A number of clinical trials have shown that ARBs are not only associated with positive outcomes across the CVD continuum but mat also have a role in the prevention or delay of diabetes (a major cardiovascular risk factor). Ongoing trials are aiming to define the place of such agents in lessening morbidity and mortality from CVD.
J Renin Angiotensin Aldosterone Syst 2006 Jun
PMID:Clinical evidence for the cardiovascular benefits of angiotensin receptor blockers. 1696 48

It is well recognised that the metabolic syndrome, a constellation of risk factors including obesity, hypertension, insulin resistance and dyslipidaemia, is associated with an increased risk of cardiovascular complications and the development of Type 2 diabetes. Consequently, timely identification and management of all components of the metabolic syndrome is warranted. In particular, guidelines have emphasised the importance of targeting elevated blood pressure (BP) and dyslipidaemia as a method of reducing global cardiovascular risk. Findings from the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial show that the angiotensin receptor blocker, valsartan, reduces cardiovascular events and the development of Type 2 diabetes in high-risk individuals. This profile is being further explored in the ongoing Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. Given the potential advantages to patients and physicians of tackling more than one of the components of the metabolic syndrome, antihypertensive agents such as valsartan would appear to be and important addition to the management of vulnerable patients at high risk of cardiovascular events.
J Renin Angiotensin Aldosterone Syst 2006 Jun
PMID:Angiotensin receptor blockers: Cardiovascular protection in the metabolic syndrome. 1698 30

A joint initiative between the National Institute for Health and Clinical Excellence (NICE) and the British Hypertension Society (BHS) has led to the publication of new guidelines for the management of hypertension in the community. Recent trial evidence highlighting the increased incidence of new-onset diabetes in those exposed to beta-blocker-based treatment regimens, with or without diuretics, compared with those based on calcium channel blockers (CCBs) or angiotensin-converting enzyme (ACE-Is) inhibitors has led to a recommendation that in the uncomplicated patient, beta-blockers are no longer considered suitable options for first-line therapy. Together with mounting evidence that age and ethnicity dictate blood pressure (BP) responsiveness to different classes of antihypertensive drugs, the ACD algorithm is now proposed (formerly ABCD), with ACE inhibitors (ACE-Is) (or angiotensin receptor blockers [ARBs] when ACE-Is are poorly tolerated) preferred in younger patients and CCBs or diuretics preferred for older patients and in black patients of any age. Pathophysiological considerations have influenced proposals for combination therapies with CCBs or diuretics added to ACE-Is in younger patients and vice versa in older patients. Health economic analyses have clearly indicated the cost effectiveness of CCBs which are now elevated to equal standing with diuretics in older patients.
J Renin Angiotensin Aldosterone Syst 2006 Jun
PMID:New hypertension guidelines from the National Institute for Health and Clinical Excellence and the British Hypertension Society. 1708 59

Type 2 diabetes has long been known to be associated with an increased risk of cardiovascular disease. Patients with type 2 diabetes have also been shown to benefit more from antihypertensive therapy than do non-diabetics with hypertension. The benefits of aggressive antihypertensive therapy are reflected in the recent reduction of blood pressure (BP) targets in international guidelines. Drugs acting on the renin-angiotensin-aldosterone system (RAAS) have well-documented efficacy, and results from large-scale trials with highly selective angiotensin II (Ang II) receptor blockers (ARBs), such as valsartan, are awaited. The VALUE trial will provide the largest body of information yet on the comparative benefits of using an ARB or calcium channel blocker in hypertensive patients with diabetes.
J Renin Angiotensin Aldosterone Syst 2000 Jun
PMID:Cardiac, renal and vascular complications in the diabetic patient. 1719 15

The ABCD (Appropriate Blood Pressure Control in Diabetes) and ABCD-2V (Part 2 with Valsartan) are prospective, randomised clinical trials which will provide important data on the impact of intensive vs. moderate blood pressure (BP) control on microvascular and macrovascular complications in normotensive and hypertensive patients with type 2 diabetes mellitus (DM). The ABCD trial was a five-year study that compared the effects of intensive vs. moderate BP control on the endpoints of nephropathy, retinopathy, neuropathy, and cardiovascular disease events using a calcium channel blocker (CCB) and an angiotensin-converting enzyme (ACE) inhibitor as the primary antihypertensive agents. The recently published results of the hypertensive cohort of ABCD are reviewed herein. The follow-up study, ABCD-2V, is ongoing and was designed to compare intensive vs. moderate BP control on the same endpoints as the ABCD study, using the highly selective angiotensin II receptor blocker (ARB) valsartan as the primary antihypertensive agent. First results of ABCD-2V are expected in 2004. The baseline characteristics for the patients enrolled thus far in the hypertensive cohort of ABCD-2V are reviewed. These studies will provide insight into the role of intensive vs. moderate BP control in the management of normotensive and hypertensive patients with type 2 DM.
J Renin Angiotensin Aldosterone Syst 2000 Jun
PMID:Improving the prognosis of diabetic patients: evaluating the role of intensive versus moderate blood pressure control with selective angiotensin II receptor blocker (ARB) therapy. 1719 16


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