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Renal protection by angiotensin II receptor antagonists in patients with type 2 diabetes

George Jerums, Mark E Cooper, Richard E Gilbert and Robert C Atkins
Med J Aust 2002; 176 (6): 296-297.
Published online: 18 March 2002

In reply: Peverill raises the question of how to integrate the new data on renal protection by angiotensin II receptor (AIIR) antagonists with existing data on cardiovascular protection by angiotensin-converting enzyme (ACE) inhibitors in patients with type 2 diabetes. An AIIR antagonist would be favoured for renal protection for a diabetic patient with hypertension and evidence of early or overt nephropathy. With regard to patients with microalbuminuria, the HOPE and MICRO-HOPE studies showed that therapy with the ACE inhibitor ramipril (10 mg/day) was associated with a 24% relative risk reduction for the development of overt nephropathy over 4.5 years.1 In contrast, treatment of similar patients with the AIIR antagonist irbesartan (300 mg/day) for 2.6 years resulted in a 70% risk reduction for the development of overt nephropathy.2 Use of an AIIR antagonist in patients with overt nephropathy has also been shown to slow progression to end-stage renal failure.3,4 As the HOPE and MICRO-HOPE studies specifically excluded such patients, evidence supporting use of an ACE inhibitor in this context is lacking.

  • George Jerums
  • Mark E Cooper
  • Richard E Gilbert
  • Robert C Atkins

  • 1 Austin and Repatriation Medical Centre, Heidelberg, VIC.
  • 2 Department of Medicine, Austin and Repatriation Medical Centre, Melbourne, VIC.
  • 3 Department of Medicine, St Vincent's Hospital, Melbourne, VIC.
  • 4 Department of Nephrology, Monash Medical Centre, Melbourne, VIC.


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