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- May 17, 2008 |
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"ACEI + ARB Therapy Should Be A Standard Treatment in People with Diabetes - Arguments Against"Dr. Phil McFarlane (biography)
English - 2005-01-21 - 25 minutes
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Summary :
In this presentation Dr. McFarlane gives an overview of the framework of cardiorenal priorities in the 2003 CDA Guidelines (1) and evidence for the use of ACE inhibitor plus angiotensin receptor blocker (ARB) combination therapy, followed by a discussion of its suitability as a standard treatment for people with diabetes.
In terms of the available evidence for combination therapy with ACEI/ARB, studies in diabetic patients show further reductions in proteinuria with combination therapy compared to one agent alone (2,3).
Not every patient with diabetes has nephropathy, however, or even hypertension (4) and variations in the ACE gene have been found to influence the antialbuminuric response to dual blockade of the renin-angiotensin system (2). A lack of hard endpoint trials in diabetic patients is another obstacle to considering ACEI/ARB combination therapy as a standard treatment in these patients, and the possibility remains to use other combinations of anti-hypertensive agents as well. Dr. McFarlane ends his presentation by interpreting the results of the CHARM-Added trial which investigated the effects on CV death/CHF hospital admission of adding an ARB to an ACEI and other treatments in patients with CHF (5).
In summary combination ACEI/ARB therapy looks promising however further clinical evidence is needed before it may become a standard treatment in diabetic patients.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The cardiorenal priorities set forth in the 2003 CDA Guidelines
- Available evidence for ACEI/ARB combination therapy in diabetic patients
- Whether ACEI/ARB combination therapy should be a standard treatment for diabetic patients
Bibliographic references :
1. CDA Guidelines 2003, CJD 2003;27 (Sup 2):S58-S65.
2. Jacobsen P, Parving HH. Beneficial impact on cardiovascular risk factors by dual blockade of the renin-angiotensin system in diabetic nephropathy.Kidney Intl.2004;66(S92):S108-S110.
3. Carl Erik Mogensen, professor of medicine a, Steen Neldam, general practitioner b, Ilkka Tikkanen, associate professor of medicine (nephrology) c, Shmuel Oren, physician d, Reuven Viskoper, physician d, Richard W Watts, physician e, Mark E Cooper, professor of medicine f, for the CALM study group. 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 (9 December).
4. Ballard DJ et al.DM. 1988;37(4):405-412.
5. 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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