ACE Inhibitors and Protection Against Kidney Disease Progression in Patients With Type 2 Diabetes: What's the Evidence?

Authors

  • George L. Bakris MD,

    1. From the Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL;1 and the Renal Division, University of Baltimore, Baltimore, MD2
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  • and 1 Matthew Weir MD 2

    1. From the Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL;1 and the Renal Division, University of Baltimore, Baltimore, MD2
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George L. Bakris, MD, Professor and Vice Chairman,
Department of Preventive Medicine, Rush-Presbyterian-St.
Luke's Medical Center, 1700 W. Van
Buren Street, Chicago, IL 60612gbakris@rush.edu

Abstract

Although angiotensin-converting enzyme inhibitors are frequently used as antihypertensive agents to lower blood pressure and slow progression of nephropathy in patients with type 2 diabetes, evidence of their efficacy has been drawn primarily from small trials with surrogate end points. No adequately powered, long-term trials have tested their effects to reduce the incidence of hard end points, such as progression to end-stage renal disease or even doubling of serum creatinine in the population of patients with nephropathy from type 2 diabetes. While the results of angiotensin-converting enzyme inhibitor trials from nondiabetic causes and even type 1 diabetes may be extrapolated to the patient with nephropathy associated with type 2 diabetes, the hard evidence is not available. This review critically evaluates the limited evidence in support of angiotensin-converting enzyme inhibitors as renal-protective agents in people with type 2 diabetes.

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