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Diabetes Watch Blog: Keep blood pressure low to protect your kidneys

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Dec 12, 2005

Keep blood pressure low to protect your kidneys

Keep blood pressure low to protect your kidneys
The best way to protect kidneys of diabetic patients is to lower blood pressure. Period. Says Juan P. Casas M.D. and his colleagues of the British Heart Foundation Laboratory at University College London. He reported that a meta-analysis of 127 randomized trials did not confirm a kidney protective effect for either ACE-inhibitors or angiotensin receptor blockers (ARBs), which are commonly, used anti- hypertensive drugs used in diabetics.

The purported benefit of either ACE inhibitors or ARBs comes from placebo-controlled studies, Dr. Casas and his colleagues reported in the recent issue of The Lancet. But when these agents were compared with other antihypertensive drugs that also substantially reduce blood pressure "there was no evidence of a significant salutary effect of ACE inhibitors or ARBs on renal outcomes in patients with diabetes."

The authors wrote that their analysis found that in patients with diabetic nephropathy there was no benefit seen in comparative trials of ACE inhibitors or ARBs on the doubling of creatinine, end-stage renal disease, glomerular filtration rate, or creatinine amounts.

On balance, the authors contended that the reported renoprotective benefit of ACE inhibitors and ARBs comes from a handful of smaller studies while the impact of drugs on end-stage renal disease and doubling of creatinine "showed a reduced benefit in large studies."

They pointed out, for example, that in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, there was no evidence for a greater beneficial effect of ACE inhibitors in people with poor renal function.

The authors found some evidence of "small benefits of the drugs" in trials of patients with non-diabetic renal disease. But those studies were small, they wrote, so the findings are subject to bias.

The take home, the authors concluded, is that the evidence does not support use of ACE inhibitors or ARBs as "first-line choices for renoprotection on the basis of efficacy, and residual uncertainty still exists about the inherent value of these drugs in other renal disorders."


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Type-2 Diabetes
Type-2 diabetes is the most common form of diabetes, accounting for 90% of cases diabetes. This disease affects nearly 17 million Americans and is the seventh leading cause of death in the United States. Even though 17 million Americans have type-2 diabetes only half of these people are aware that they have diabetes. The death rate in patients with diabetes may be up to 11 times higher than in persons without the disease. The occurrence of diabetes in persons 45 to 64 years of age is 7 percent, but the proportion increases significantly in persons 65 years of age or older. Type-2 diabetes accounts for more than 90% of all diabetes worldwide.

Diabetes Watch Blog: Keep blood pressure low to protect your kidneys

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