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Diabetic Retinopathy, But Not Nephropathy, Benefits from Renin-Angiotensin Blockade
In type 1 diabetes, blockade of the renin-angiotensin system to prevent nephropathy "is not supported," a New England Journal of Medicine study finds.
Study investigators randomized some 300 patients with type 1 diabetes to daily therapy with either the angiotensin-receptor blocker losartan, the ACE inhibitor enalapril, or placebo, and followed them for 5 years. At baseline, all patients were normotensive, normoalbuminuric, and did not have retinopathy.
At follow-up, histopathologic changes (increased mesangial volume relative to baseline renal biopsy) were similar among the three groups. Losartan was associated with a faster progression of albuminuria. Renin-angiotensin blockade did, however, have a salutary effect on retinopathy, with reductions in progression by about two thirds relative to placebo.
Editorialists say the results change accepted concepts about diabetic nephropathy, and that further work will be needed before renin-angiotensin blockade to prevent retinopathy can be used in clinical practice.
LINK(S):
NEJM article (Free abstract; full text requires subscription)
NEJM editorial (Subscription required)
Published in Physician's First Watch July 2, 2009
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