Key result
The review discusses the role of AT1 receptor blockers in preventing diabetes and reducing cardiovascular endpoints, highlighting insights from the ONTARGET trial.
Why the study?
Is selective AT1-receptor blockade superior to ACE inhibition in preventing diabetes and reducing cardiovascular endpoints in diabetic patients, and is an ARB with PPARgamma-activating properties superior to one without?
Is selective AT1-receptor blockade superior to ACE inhibition in preventing diabetes and reducing cardiovascular endpoints in diabetic patients, and is an ARB with PPARgamma-activating properties superior to one without?
This review explores the mechanisms and clinical evidence, particularly from the ONTARGET trial, regarding the use of ARBs for cardiovascular protection and diabetes prevention in at-risk populations.
Does not yet support changing practice from ACE inhibitors to ARBs for diabetes prevention; leaves open superiority of selective AT1 blockade or PPARgamma activation.
BACKGROUND: Angiotensin type 1 (AT1) receptor blockers (ARBs) are used to treat hypertension and related end-organ damage. ARBs have been recognised as regulators of glucose- and lipid metabolism. Clinical trials demonstrated that AT1 receptor antagonism lowers the risk for type 2 diabetes compared with other antihypertensive therapies. Blockade of AT1 receptors reduces cardiovascular morbidity and mortality in diabetic subpopulations. The mechanisms of the insulin-sensitizing/anti-diabetic effect are not fully understood, and may involve AT1 receptor-dependent pathways and 'pleiotropic' actions of ARBs including activation of insulin-sensitising PPARgamma. OBJECTIVE: In clinical practice questions about AT1 receptor blockade in diabetes have to be answered. Firstly, is selective AT1-receptor blockade superior to ACE inhibition in preventing diabetes and reducing cardiovascular end points in diabetic patients? Secondly, is an ARB with PPARgamma-activating properties superior to one without this action? RESULTS/CONCLUSION: The Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) has provided information to answer these questions, and is discussed.
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Kintscher et al. (2008) conducted a review in Diabetes. Angiotensin type 1 (AT1) receptor blockers vs. ACE inhibition or other antihypertensive therapies was evaluated. The review discusses the role of AT1 receptor blockers in preventing diabetes and reducing cardiovascular endpoints, highlighting insights from the ONTARGET trial.
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