Value of Angiotensin Receptor Blocker Therapy in Diabetes
Article first published online: 5 APR 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 4, pages 290–295, April 2011
How to Cite
Izzo Jr, J. L. and Zion, A. S. (2011), Value of Angiotensin Receptor Blocker Therapy in Diabetes. The Journal of Clinical Hypertension, 13: 290–295. doi: 10.1111/j.1751-7176.2011.00447.x
- Issue published online: 5 APR 2011
- Article first published online: 5 APR 2011
- Manuscript received January 11, 2011; revised January 31, 2011; accepted January 31, 2011
There are more clinical trials investigating angiotensin receptor blockers (ARBs) in diabetes than any other drug class, ranging from early “prevention” trials to the treatment of individuals with advanced organ damage. In its earliest manifestations, visceral adiposity predisposes to hypertension and hyperglycemia (metabolic syndrome). In these individuals, ARB therapy delays the progression to chronic hypertension and may also delay the progression to overt diabetes. Based on the increased cardiovascular disease risk of the metabolic syndrome, which is similar to stage 1 hypertension, both lifestyle modification and ARB therapy are justifiable. ARB therapy has also been found to delay the onset of microalbuminuria and retinopathy. In established diabetic nephropathy, ARB therapy is recommended as a standard alternative to angiotensin-converting enzyme inhibition to reduce macroalbuminuria and delay the progression to end-stage disease. Finally, large trials in ischemic heart disease, heart failure, and stroke have demonstrated clear benefits of ARB therapy. Because ARBs have side effect rates equal to placebo and far lower than any other antihypertensive drug class, the benefit/risk ratio is highly favorable across the entire spectrum of diabetic disease. Thus, ARB therapy is a highly attractive alternative for individuals at any stage of diabetes and with any pattern of complications. J Clin Hypertens (Greenwich). 2011;13:290–295. © 2011 Wiley Periodicals, Inc.