Current Diabetes Reports

, Volume 10, Issue 1, pp 32–36

Pleiotropic Effects of Inhibitors of the RAAS in the Diabetic Population: Above and Beyond Blood Pressure Lowering

  • Haisam Ismail
  • Rena Mitchell
  • Samy I. McFarlane
  • Amgad N. Makaryus
Article

DOI: 10.1007/s11892-009-0081-y

Cite this article as:
Ismail, H., Mitchell, R., McFarlane, S.I. et al. Curr Diab Rep (2010) 10: 32. doi:10.1007/s11892-009-0081-y

Abstract

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are indispensable therapeutic agents for treating hypertension and proteinuria in patients with diabetes mellitus. Studies have shown that the renin-angiotensin-aldosterone system (RAAS) has effects on various organ systems, including the central nervous system, heart, and kidneys. Angiotensin II has major deleterious effects on vascular compliance, vascular relaxation, and plasma markers of inflammation, which are surrogate markers of cardiovascular disease. Evidence is established from major trials that ACE inhibitors and ARB therapy improve these surrogate markers and reduce cardiovascular disease, renal disease, and stroke. Accumulating evidence also supports the newer class of medication, the direct renin inhibitor aliskiren, as beneficial in hypertensive persons with diabetes mellitus. In this article, we review the mechanisms through which inhibitors of the RAAS benefit persons with hypertension and decrease the development of cardiovascular and renal disease above and beyond blood pressure lowering.

Keywords

Angiotensin-converting enzyme inhibitorsAngiotensin receptor blockersRenin-angiotensin-aldosterone systemDiabetes

Clinical Trial Acronyms

ALLAY

Aliskiren Left Ventricular Assessment of Hypertrophy

ALOFT

Aliskiren Observation of Heart Failure Treatment

ALTITUDE

Aliskiren Trial in Type 2 Diabetes Using Cardiovascular and Renal Disease Endpoints

AVOID

Aliskiren in the Evaluation of Proteinuria in Diabetes

CAPPP

Captopril Prevention Project

HOPE

Heart Outcomes Prevention Evaluation

MICRO-HOPE

Microalbuminuria, Cardiovascular and Renal Outcomes

ONTARGET

Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Haisam Ismail
    • 1
  • Rena Mitchell
    • 2
  • Samy I. McFarlane
    • 2
  • Amgad N. Makaryus
    • 1
  1. 1.Department of CardiologyNorth Shore University HospitalManhassetUSA
  2. 2.State University of New York-Downstate Medical CenterBrooklynUSA