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[The ACE inhibitor spirapril in chronic renal failure, hypertension and diabetic nephropathy]
Insights
Tight blood pressure control is crucial for patients with arterial hypertension and diabetes. Angiotensin-converting enzyme (ACE) inhibitors are recommended for managing hypertension and diabetic nephropathy, improving cardiovascular outcomes.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Context:
- Arterial hypertension (AH) and diabetes mellitus (DM) management guidelines emphasize strict blood pressure (BP) control.
- Clinical trials demonstrate improved outcomes with reduced cardiovascular events in diabetic AH patients achieving tight BP control.
Purpose:
- To highlight the importance of tight BP control in arterial hypertension, particularly in patients with diabetes mellitus.
- To emphasize the role of ACE inhibitors as a cornerstone in managing diabetic nephropathy and hypertension.
Summary:
- Evidence supports tight BP control in arterial hypertension (AH), especially in patients with diabetes mellitus (DM), leading to fewer cardiovascular events.
- ACE inhibition is considered optimal for diabetic nephropathy and microalbuminuria, offering benefits beyond simple hemodynamic changes.
- For patients with renal failure, drugs like spirapril with non-renal elimination are recommended to avoid accumulation and adverse effects.
Impact:
- Establishes ACE inhibitors as a primary therapeutic strategy for AH and nephropathy in DM and other renal diseases.
- Informs clinical practice regarding optimal antihypertensive drug selection, particularly in complex patient populations.
- Suggests specific drug considerations (e.g., spirapril) for patients with renal impairment to ensure safety and efficacy.
Abstract:
The evidence from recent clinical outcome trials in arterial hypertension (AH) and the treatment guidelines from national and international authorities have placed a clear emphasis on "tight" blood pressure (BP) control. This has been particularly well illustrated in the treatment of patients with diabetes mellitus and AH where "tight" BP control clearly improves the outcome with reduced numbers of fatal and non-fatal cardiovascular events. Whilst the clinical trials in AH have identified benefits through BP reduction with a range of antihypertensive drugs there is a considerable volume of evidence to suggest that the optimal treatment for diabetic nephropathy and microalbuminuria should be based upon ACE inhibition. It is widely held that inhibition of intra-renal renin angiotensin systems leads to greater benefit than can be achieved by hemodynamic changes alone. Thus, management of AH and nephropathy in both DM and other forms of renal disease revolves around BP reduction through an ACE inhibitor-based treatment regimen. Where there is renal failure it may be prudent to administer a drug such as spirapril which has non-renal elimination mechanisms and which has been shown to have no accumulation problems or increased adverse effects.