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[Prevention of type II diabetes by inhibiting the renin-angiotensin system]

A J Scheen1

  • 1Université de Liège, Service de Diabétologie, Nutrition et Maladies métaboliques, Département de Médecine.

Revue Medicale De Liege
|September 18, 2002
PubMed

Insights

Inhibition of the renin-angiotensin system may reduce type 2 diabetes risk in hypertensive patients. Ongoing trials are confirming if these blood pressure medications offer significant protection against diabetes development.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Context:

  • Type 2 diabetes mellitus and arterial hypertension are key components of the insulin resistance syndrome.
  • Insulin resistance involves both metabolic and hemodynamic factors, including endothelial dysfunction.
  • Angiotensin-converting enzyme inhibitors have been suggested to improve insulin sensitivity.

Purpose:

  • To evaluate the impact of renin-angiotensin system inhibition on the development of type 2 diabetes in high-risk patients.
  • To confirm findings from previous trials where renin-angiotensin system inhibitors showed a reduced risk of type 2 diabetes as a secondary outcome.

Summary:

  • Three clinical trials (CAPPP, HOPE, LIFE) indicated that renin-angiotensin system inhibition significantly lowers the risk of developing type 2 diabetes in hypertensive individuals.
  • Captopril, ramipril, and losartan demonstrated risk reductions of 14%, 34%, and 25%, respectively.
  • These findings, though promising, were based on secondary endpoints, necessitating further dedicated research.

Impact:

  • Two large prospective, randomized, double-blind trials are currently underway to specifically validate the hypothesis that renin-angiotensin system inhibition prevents type 2 diabetes.
  • Results from these ongoing trials could influence clinical guidelines for managing hypertension and preventing diabetes.
  • Understanding the hemodynamic component of insulin resistance may lead to novel therapeutic strategies.

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