Angiotensin receptor blockade in diabetic renal disease--focus on candesartan

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Diabetic renal disease management requires strict blood pressure and glycaemic control.
• Hypertension is a major risk factor for diabetic renal disease progression.
• Angiotensin receptor blockers (ARBs) are increasingly recognized for their renoprotective effects.

Purpose of the Study:

• To review the evidence supporting ARBs in treating hypertension in type 2 diabetic patients with diabetic renal disease.
• To highlight the efficacy of candesartan in blood pressure control and kidney protection.
• To discuss the role of ARBs in managing cardiovascular risk in this population.

Main Methods:

• Review of recent clinical evidence and guidelines regarding ARB use.
• Analysis of studies evaluating candesartan's effects on blood pressure and urinary albumin excretion (UAE).
• Examination of data on dual blockade with ARBs and ACE inhibitors.

Main Results:

• Candesartan treatment (8-32mg daily) reduced UAE by up to 60% in type 2 diabetes patients with albuminuria.
• Dual blockade with an ACE inhibitor and candesartan further reduced UAE by 25-35% compared to ACE inhibitor monotherapy.
• ARBs are considered a first-choice antihypertensive treatment for type 2 diabetes with diabetic renal disease.

Conclusions:

• ARBs, particularly candesartan, are effective in managing hypertension and reducing albuminuria in type 2 diabetes.
• Dual blockade with ARBs and ACE inhibitors offers additional renoprotective benefits.
• Comprehensive management including blood pressure, glycaemic control, and cardiovascular risk is crucial for diabetic renal disease.