open access

Vol 9, No 3 (2020)
REVIEW ARTICLES
Published online: 2020-02-05
Get Citation

Protective effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs) on microalbuminuria in diabetic patients

Enas Elsafa, Pirzado Zahid Ali
DOI: 10.5603/DK.2020.0002
·
Clinical Diabetology 2020;9(3):193-200.

open access

Vol 9, No 3 (2020)
REVIEW ARTICLES
Published online: 2020-02-05

Abstract

This review assesses the protective effect of ACEIs and ARBs on microalbuminuria in diabetic patients and identifying the preferred type based on their beneficial effects in addition to their blood pressure-reducing effect in diabetic patients with microalbuminuria and adverse drug reaction profile. In this review, articles published between 2001 and 2019 are included and MEDLINE search was used with key words such as diabetes, microalbuminuria, angiotensin II receptor antagonists, and ACEIs. ARBs reduced the risks of end stage renal disease (ESRD) and two-fold rise in the serum creatinine level; ACEIs did not reduce the risks of ESRD in an analysis of studies including both type 1 and type 2 diabetic patients. However, a meta-analytical review or study needs to be conducted to evaluate the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients. Early treatment with ACEIs or ARBs decreased the risk of microalbuminuria in patients with type 2 diabetes. Telmisartan is found to be beneficial in microalbuminuria or diabetic nephropathy. Long-term therapy with higher dose of irbesartan resulted in consistent protective effects on the renal functions even after its withdrawal. ACEIs or ARBs are consideredas the 1st-line therapy in both type 1 and 2 diabetic patients with microalbuminuria. ARBs are definitely preferred for patients who cannot tolerate ACE inhibitors. ARBs may be preferred over ACEIs due to their predominant renal protective effects in addition to their beneficial effect of improving blood pressure in type 2 diabetes mellitus. However, the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients with microalbuminuria needs to be further evaluated in a randomized controlled study.

Abstract

This review assesses the protective effect of ACEIs and ARBs on microalbuminuria in diabetic patients and identifying the preferred type based on their beneficial effects in addition to their blood pressure-reducing effect in diabetic patients with microalbuminuria and adverse drug reaction profile. In this review, articles published between 2001 and 2019 are included and MEDLINE search was used with key words such as diabetes, microalbuminuria, angiotensin II receptor antagonists, and ACEIs. ARBs reduced the risks of end stage renal disease (ESRD) and two-fold rise in the serum creatinine level; ACEIs did not reduce the risks of ESRD in an analysis of studies including both type 1 and type 2 diabetic patients. However, a meta-analytical review or study needs to be conducted to evaluate the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients. Early treatment with ACEIs or ARBs decreased the risk of microalbuminuria in patients with type 2 diabetes. Telmisartan is found to be beneficial in microalbuminuria or diabetic nephropathy. Long-term therapy with higher dose of irbesartan resulted in consistent protective effects on the renal functions even after its withdrawal. ACEIs or ARBs are consideredas the 1st-line therapy in both type 1 and 2 diabetic patients with microalbuminuria. ARBs are definitely preferred for patients who cannot tolerate ACE inhibitors. ARBs may be preferred over ACEIs due to their predominant renal protective effects in addition to their beneficial effect of improving blood pressure in type 2 diabetes mellitus. However, the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients with microalbuminuria needs to be further evaluated in a randomized controlled study.

Get Citation

Keywords

angiotensin, enzyme inhibitors, receptor blockers, microalbuminuria, diabetes, renal, protective effects

About this article
Title

Protective effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs) on microalbuminuria in diabetic patients

Journal

Clinical Diabetology

Issue

Vol 9, No 3 (2020)

Pages

193-200

Published online

2020-02-05

DOI

10.5603/DK.2020.0002

Bibliographic record

Clinical Diabetology 2020;9(3):193-200.

Keywords

angiotensin
enzyme inhibitors
receptor blockers
microalbuminuria
diabetes
renal
protective effects

Authors

Enas Elsafa
Pirzado Zahid Ali

References (40)
  1. Wang K, Hu J, Luo T, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality and renal outcomes in patients with diabetes and albuminuria: a systematic review and meta-analysis. Kidney Blood Press Res. 2018; 43(3): 768–779.
  2. Furat C, Dogan R, Ilhan G, et al. Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting. Cardiovasc J Afr. 2017; 28(3): 191–195.
  3. Uzu T, Araki SI, Kashiwagi A, et al. Shiga Committee for Preventing Diabetic Nephropathy. Comparative Effects of Direct Renin Inhibitor and Angiotensin Receptor Blocker on Albuminuria in Hypertensive Patients with Type 2 Diabetes. A Randomized Controlled Trial. PLoS One. 2016; 11(12): e0164936.
  4. Persson F, Lindhardt M, Rossing P, et al. Prevention of microalbuminuria using early intervention with renin-angiotensin system inhibitors in patients with type 2 diabetes: A systematic review. J Renin Angiotensin Aldosterone Syst. 2016; 17(3).
  5. Mercier K, Smith H, Biederman J. Renin-angiotensin-aldosterone system inhibition: overview of the therapeutic use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors. Prim Care. 2014; 41(4): 765–778.
  6. Satchell SC, Tooke JE. What is the mechanism of microalbuminuria in diabetes: a role for the glomerular endothelium? Diabetologia. 2008; 51(5): 714–725.
  7. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005; 28(Supplement 1): S4–S36.
  8. Basi S, Fesler P, Mimran A, et al. Microalbuminuria in type 2 diabetes and hypertension: a marker, treatment target, or innocent bystander? Diabetes Care. 2008; 31 Suppl 2: S194–S201.
  9. Marre M, Lievre M, Chatellier G, et al. DIABHYCAR Study Investigators. Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study). BMJ. 2004; 328(7438): 495.
  10. Yao B, Hu G, Li Y, et al. The effect of perindopril in treatment of early diabetic nephropathy with normal blood pressure and microalbuminuria. Zhonghua Nei Ke Za Zhi. 2001; 40(12): 826–828.
  11. Jerums G, Allen TJ, Campbell DJ, et al. Melbourne Diabetic Nephropathy Study Group. Long-term renoprotection by perindopril or nifedipine in non-hypertensive patients with type 2 diabetes and microalbuminuria. Diabet Med. 2004; 21(11): 1192–1199.
  12. Kopf D, Schmitz H, Beyer J, et al. A double-blind trial of perindopril and nitrendipine in incipient diabetic nephropathy. Diabetes Nutr Metab. 2001; 14(5): 245–252.
  13. Raff U, Ott C, Ruilope LM, et al. Prevention of electrocardiographic left ventricular remodeling by the angiotensin receptor blocker olmesartan in patients with type 2 diabetes. J Hypertens. 2014; 32(11): 2267–76; discussion 2276.
  14. Currie G, Bethel MA, Holzhauer B, et al. Effect of valsartan on kidney outcomes in people with impaired glucose tolerance. Diabetes Obes Metab. 2017; 19(6): 791–799.
  15. Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001; 345(12): 861–869.
  16. Ruilope LM, Segura J. Losartan and other angiotensin II antagonists for nephropathy in type 2 diabetes mellitus: a review of the clinical trial evidence. Clin Ther. 2003; 25(12): 3044–3064.
  17. Woo V, Ni LS, Hak D, et al. Effects of losartan on urinary secretion of extracellular matrix and their modulators in type 2 diabetes mellitus patients with microalbuminuria. Clin Invest Med. 2006; 29(6): 365–372.
  18. Weil EJ, Fufaa G, Jones LI, et al. Effect of losartan on prevention and progression of early diabetic nephropathy in American Indians with type 2 diabetes. Diabetes. 2013; 62(9): 3224–3231.
  19. Agha A, Amer W, Anwar E, et al. Reduction of microalbuminuria by using losartan in normotensive patients with type 2 diabetes mellitus: A randomized controlled trial. Saudi J Kidney Dis Transpl. 2009; 20(3): 429–435.
  20. Zandbergen AAM, Lamberts SWJ, Baggen MGA, et al. Effect of losartan on microalbuminuria in normotensive patients with type 2 diabetes mellitus. A randomized clinical trial. Ann Intern Med. 2003; 139(2): 90–96.
  21. Andersen S, Bröchner-Mortensen J, Parving HH, et al. Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria Study Group. Kidney function during and after withdrawal of long-term irbesartan treatment in patients with type 2 diabetes and microalbuminuria. Diabetes Care. 2003; 26(12): 3296–3302.
  22. Schmieder RE, Bakris G, Weir MR. Telmisartan in incipient and overt diabetic renal disease. J Nephrol. 2011; 24(3): 263–273.
  23. Joshi SR, Yeolekar ME, Tripathi KK, et al. LORD Trial. Evaluation of efficacy and tolerability of Losartan and Ramipril combination in the management of hypertensive patients with associated diabetes mellitus in India (LORD Trial). J Assoc Physicians India. 2004; 52: 189–195.
  24. Tütüncü NB, Gürlek A, Gedik O. Efficacy of ACE inhibitors and ATII receptor blockers in patients with microalbuminuria: a prospective study. Acta Diabetol. 2001; 38(4): 157–161.
  25. American Diabetes Association Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019; 42: S107–108.
  26. Indicators for the NICE menu for the QOF. National Institute for Health and Care Excellence. (Available at: https://www.nice.org.uk/Media/Default/Standards-and-indicators/QOF%20Indicator%20Key%20documents/nm95-dm-guidance.pdf. Last Accessed 12 August. 2019; 2015: 1–3.
  27. Renin-angiotensin system drugs: dual therapy. National Institute for Health and Care Excellence. (Avalable at: https://www.nice.org.uk/advice/ktt2/chapter/evidence-context. Last Accessed 12 August. 2019; 2015: 1–6.
  28. National Kidney Foundation. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. Am J Kidney Dis. 2012; 60(5): 850–886.
  29. Vejakama P, Thakkinstian A, Lertrattananon D, et al. Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. Diabetologia. 2012; 55(3): 566–578.
  30. Gu J, Yang M, Qi Na, et al. Olmesartan Prevents Microalbuminuria in db/db Diabetic Mice Through Inhibition of Angiotensin II/p38/SIRT1-Induced Podocyte Apoptosis. Kidney Blood Press Res. 2016; 41(6): 848–864.
  31. Xu ZG, Yoo TH, Ryu DR, et al. Angiotensin II receptor blocker inhibits p27Kip1 expression in glucose-stimulated podocytes and in diabetic glomeruli. Kidney Int. 2005; 67(3): 944–952.
  32. Zhou G, Cheung AK, Liu X, et al. Valsartan slows the progression of diabetic nephropathy in db/db mice via a reduction in podocyte injury, and renal oxidative stress and inflammation. Clin Sci (Lond). 2014; 126(10): 707–720.
  33. Esmatjes E, Flores L, Iñigo P, et al. Effect of losartan on TGF-beta1 and urinary albumin excretion in patients with type 2 diabetes mellitus and microalbuminuria. Nephrol Dial Transplant. 2001; 16 Suppl 1: 90–93.
  34. Houlihan CA, Akdeniz A, Tsalamandris C, et al. Urinary transforming growth factor-beta excretion in patients with hypertension, type 2 diabetes, and elevated albumin excretion rate: effects of angiotensin receptor blockade and sodium restriction. Diabetes Care. 2002; 25(6): 1072–1077.
  35. Hill C, Logan A, Smith C, et al. Angiotensin converting enzyme inhibitor suppresses glomerular transforming growth factor beta receptor expression in experimental diabetes in rats. Diabetologia. 2001; 44(4): 495–500.
  36. McLennan SV, Kelly DJ, Cox AJ, et al. Decreased matrix degradation in diabetic nephropathy: effects of ACE inhibition on the expression and activities of matrix metalloproteinases. Diabetologia. 2002; 45(2): 268–275.
  37. Bonnet F, Cooper ME, Kawachi H, et al. Irbesartan normalises the deficiency in glomerular nephrin expression in a model of diabetes and hypertension. Diabetologia. 2001; 44(7): 874–877.
  38. Ertürküner SP, Başar M, Tunçdemir M, et al. The comparative effects of perindopril and catechin on mesangial matrix and podocytes in the streptozotocin induced diabetic rats. Pharmacol Rep. 2014; 66(2): 279–287.
  39. Cordonnier DJ, Pinel N, Barro C, et al. Expansion of cortical interstitium is limited by converting enzyme inhibition in type 2 diabetic patients with glomerulosclerosis. The Diabiopsies Group. J Am Soc Nephrol. 1999; 10(6): 1253–1263.
  40. Caldeira D, David C, Sampaio C. Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors: a systematic review and meta-analysis. Am J Cardiovasc Drugs. 2012; 12(4): 263–277.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl