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- May 16, 2008 |
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"ACE-I and ARB Combination Therapy Should Be a Standard Treatment for People with Diabetes"Dr. Alice Cheng (biography)
English - 2005-01-21 - 27 minutes
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Summary :
In this presentation Dr. Cheng presents evidence for the use of angiotensin converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) combination therapy in patients with type 2 diabetes.
Combination therapy with ACE-I/ARB provides more complete inhibition of the renin-angiotensin system than either agent alone, and additive and compensatory benefits based on their mechanisms of action.
Monotherapy with ACE-Is or ARBs are known to reduce renal outcomes in patients with diabetes, however the CALM study among others have shown greater reductions in blood pressure and urinary albumin excretion with combination therapy compared to monotherapy in patients with evidence of diabetic renal disease (1).
Several studies have shown improvement in cardiovascular morbidity and mortality attributable to monotherapy with ACE-Is or ARBs in patients with diabetes, and Dr. Cheng reviews the Val-HEFT and CHARM-Added trials which looked at the effects of ACE-I/ARB combination therapy in diabetic and non-diabetic patients with congestive heart failure (2,3).
Finally, Dr. Cheng reviews the side effects of ACE-Is and ARBs and shows evidence indicating the safety of using these two agents in combination.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Mechanism of action of ACE inhibitors and ARBs
- Effects of ACE-I/ARB combination therapy on blood pressure control and ACR in type 2 diabetic patients with renal disease
- Effects of ACE-I/ARB combination therapy in patients with and without diabetes, with congestive heart failure
- Safety of ACE-I/ARB combination therapy
Bibliographic references :
1. Carl Erik Mogensen, Steen Neldam, Ilkka Tikkanen, Shmuel Oren, Reuven Viskoper, Richard W Watts, Mark E Cooper. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study BMJ 2000;321:1440-1444.
2. Jay N. Cohn, M.D., Gianni Tognoni, M.D., for the Valsartan Heart Failure Trial Investigators. A Randomized Trial of the Angiotensin-Receptor Blocker Valsartan in Chronic Heart Failure NEJM. 2001;345:1667-1675.
3. McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA; CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial.
Lancet. 2003 Sep 6;362(9386):767-71.
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