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Optimizing antihypertensive therapy in patients with diabetic nephropathy
E Ritz1, I Rychlík, G Miltenberger-Miltenyi
1Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany.
Summary
Diabetic nephropathy is rising, particularly in non-insulin-dependent diabetes mellitus (NIDDM). Angiotensin II receptor antagonists may offer significant benefits beyond blood pressure reduction for these patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Endocrinology
Background:
- Increasing incidence of diabetic nephropathy, especially in non-insulin-dependent diabetes mellitus (NIDDM).
- Limited efficacy of current treatments and poor survival rates for NIDDM patients with renal replacement therapy.
- Cardiovascular diseases are a major cause of mortality, with hypertension as a key contributing factor.
Purpose of the Study:
- To evaluate the effects of angiotensin II receptor antagonists on nephropathy in NIDDM patients.
- To investigate the benefits of renin-angiotensin system blockade beyond blood pressure reduction.
- To assess the role of angiotensin II receptor antagonists in improving outcomes for diabetic patients.
Main Methods:
- The Irbesartan Diabetic Nephropathy Trial (IDNT) is a major ongoing study.
- Approximately 1650 NIDDM patients are being randomly assigned to placebo, irbesartan, or amlodipine.
- Baseline characteristics of the initial cohort are presented.
Main Results:
- The IDNT has enrolled a significant portion of its planned participants.
- Baseline data from the initial cohort are available for analysis.
- Ongoing trials aim to provide crucial data on treatment efficacy.
Conclusions:
- Blockade of the renin-angiotensin system is well-established for managing diabetes.
- Angiotensin II receptor antagonists offer potentially superior blockade and tolerability.
- Trials like IDNT are vital for establishing the broader benefits of these agents in diabetic treatment.