PMID- 12165170
OWN - NLM
STAT- MEDLINE
DCOM- 20030124
LR  - 20101118
IS  - 1520-9156 (Print)
IS  - 1520-9156 (Linking)
VI  - 4
IP  - 3
DP  - 2002
TI  - Combination antihypertensive therapy in the treatment of diabetic nephropathy.
PG  - 313-21
AB  - Diabetic nephropathy is one of the major causes of end-stage renal disease and is 
      often associated with other macrovascular complications such as ischemic heart 
      disease and peripheral vascular disease. Angiotensin converting enzyme inhibitors 
      (ACE-I) and angiotensin II receptor blockers (AIIR) have both been shown to have 
      a protective effect on the progression of diabetic nephropathy and have thus 
      become the first choice for treatment of hypertension and/or renal involvement in 
      patients with diabetes. However, most of these patients, especially those with 
      type 2 diabetes, require two of more medications in order to reduce their blood 
      pressure to the levels, which have been proposed in recently published consensus 
      papers. These target blood pressure levels are 130/80 mm Hg in diabetic subjects 
      with proteinuria of up to 1 g/day and 125/75 mm Hg in those with proteinuria in 
      excess of 1 g/day. Combinations of different medications may have a synergistic 
      effect. Some of the early studies using a combination of either a 
      nondihydropyridine or a dihydropyridine calcium channel blocker with ACE-I 
      demonstrated a synergistic effect on proteinuria in patients with diabetic 
      nephropathy. However, these studies have not been substantiated, but calcium 
      channel blockers, with their proven ability to reduce blood pressure, play an 
      important role in the treatment of patients with diabetic nephropathy and 
      hypertension. The combination of ACE-I with AIIR may have several theoretical 
      advantages. Many studies using this combination have been performed in animal 
      models of diabetes and in patients with diabetic and nondiabetic renal disease. 
      Some of these studies have demonstrated a synergistic effect of the combination 
      on proteinuria or hypertension, but the results have not been consistent in all 
      studies. It may be concluded that, until additional studies provide more 
      convincing evidence, this combination could be used in patients whose proteinuria 
      or hypertension has not responded to either one of the agents as monotherapy or 
      to a combination of other medications.
FAU - Boner, Geoffrey
AU  - Boner G
AD  - Institute of Hypertension and Kidney Diseases, Rabin Medical Center, Beilinson 
      Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel 
      Aviv, Israel. gboner@clalit.org.il
FAU - Cao, Zemin
AU  - Cao Z
FAU - Cooper, Mark E
AU  - Cooper ME
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Diabetes Technol Ther
JT  - Diabetes technology & therapeutics
JID - 100889084
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Calcium Channel Blockers)
SB  - IM
MH  - *Angiotensin Receptor Antagonists
MH  - Angiotensin-Converting Enzyme Inhibitors/adverse effects/*pharmacology
MH  - Animals
MH  - Antihypertensive Agents/adverse effects/pharmacology
MH  - Calcium Channel Blockers/adverse effects/*pharmacology
MH  - Clinical Trials as Topic
MH  - Diabetic Nephropathies/complications/*drug therapy
MH  - Drug Synergism
MH  - Drug Therapy, Combination
MH  - Humans
MH  - Hypertension, Renal/*drug therapy
MH  - Kidney/blood supply/drug effects
MH  - Kidney Failure, Chronic/etiology/prevention & control
MH  - Proteinuria/drug therapy
MH  - Rats
MH  - Renal Circulation/drug effects
MH  - Treatment Outcome
RF  - 56
EDAT- 2002/08/08 10:00
MHDA- 2003/01/25 04:00
CRDT- 2002/08/08 10:00
PHST- 2002/08/08 10:00 [pubmed]
PHST- 2003/01/25 04:00 [medline]
PHST- 2002/08/08 10:00 [entrez]
AID - 10.1089/152091502760098456 [doi]
PST - ppublish
SO  - Diabetes Technol Ther. 2002;4(3):313-21. doi: 10.1089/152091502760098456.