Why the study?
Does aggressive blockade of the renin-angiotensin system improve renoprotection in patients with diabetic nephropathy compared to conventional single-agent therapy?
Does aggressive blockade of the renin-angiotensin system improve renoprotection in patients with diabetic nephropathy compared to conventional single-agent therapy?
Aggressive blockade of the renin-angiotensin system, potentially through dual blockade or addition of aldosterone antagonists, may offer superior renoprotection in diabetic nephropathy compared to conventional single-agent therapy, though long-term data are needed.
Short-term data favor aggressive RAS blockade for renoprotection in diabetic nephropathy; long-term trials needed before practice change.
PURPOSE OF REVIEW: This review summarizes recent studies designed to identify improved treatments for diabetic nephropathy. RECENT FINDINGS: Recent data support the concept that angiotensin converting enzyme inhibitors and angiotensin II receptor blockers have similar renoprotective effects. Aggressive blockade of the renin-angiotensin system appears to have benefits beyond those achieved with conventional doses of single agents. Dual blockade using angiotensin converting enzyme inhibitors and angiotensin II receptor blockers is effective. Aldosterone receptor antagonists may potentiate the effect of these two classes of compounds. It remains unclear, however, whether maximum benefit can be obtained by the combination of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers or aldosterone receptor antagonists as compared to larger doses of single agents. Not enough data are available currently to recommend thiazolidinedione hypoglycemic agents for renal protection. Trials are being conducted with several new classes of agents. SUMMARY: Evidence from short-term studies favors aggressive blockade of the renin-angiotensin system. Long-term studies, however, remain to be performed. A multifactorial approach that incorporates established interventions affords our best means to retard the progression of diabetic nephropathy.
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Lit et al. (2006) studied this question.
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