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Antihypertensive therapy in diabetes: the legacy effect and RAAS blockade

Massimo Volpe1, Francesco Cosentino, Giuliano Tocci

  • 1Division of Cardiology, II Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa, 1035-9, 00189 Rome, Italy. massimo.volpe@uniroma1.it

Current Hypertension Reports
|April 14, 2011
PubMed

Insights

Sustained blood pressure control is vital for diabetic patients. While intensive hyperglycemia management offers lasting cardiovascular benefits, the positive effects of antihypertensive strategies in diabetes may not persist without continuous treatment, especially concerning renin-angiotensin-aldosterone system blockade.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • The United Kingdom Prospective Diabetes Study (UKPDS) highlighted long-term cardiovascular benefits from early hyperglycemia treatment.
  • However, UKPDS follow-up studies indicated that intensive antihypertensive strategies in diabetic patients did not yield sustained cardiovascular protection.
  • This suggests that sustained blood pressure control is critical, but the protective effects of certain antihypertensive classes might offer more than just immediate blood pressure reduction.

Purpose of the Study:

  • To critically review the evidence for a potential "legacy effect" of renin-angiotensin-aldosterone system (RAAS) blockade in hypertensive patients with diabetes.
  • To explore the mechanistic rationale behind persistent cardiovascular benefits from RAAS blockade, even after treatment cessation.

Main Methods:

  • Review of existing scientific literature and clinical studies.
  • Analysis of data from post-monitoring follow-up studies of the UKPDS.
  • Exploration of molecular and cellular mechanisms related to cardiac and vascular remodeling.

Main Results:

  • Early intensive hyperglycemia treatment in UKPDS showed enduring benefits for cardiovascular mortality.
  • Sustained antihypertensive treatment was deemed crucial, as non-sustained strategies did not prevent cardiovascular events.
  • Evidence suggests that RAAS blockade may have persistent benefits beyond immediate blood pressure control.

Conclusions:

  • While sustained blood pressure control is essential for diabetic patients, the protective effects of antihypertensive therapy may not always persist.
  • Renin-angiotensin-aldosterone system (RAAS) blockade presents a potential exception, with evidence suggesting a "legacy effect" that could offer long-term cardiovascular protection.
  • Further research is warranted to fully understand and leverage the persistent benefits of RAAS blockade in managing hypertension in diabetic populations.

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