Current Diabetes Reports

, Volume 10, Issue 1, pp 32–36 | Cite as

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


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.


Angiotensin-converting enzyme inhibitors Angiotensin receptor blockers Renin-angiotensin-aldosterone system Diabetes 

Clinical Trial Acronyms


Aliskiren Left Ventricular Assessment of Hypertrophy


Aliskiren Observation of Heart Failure Treatment


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


Aliskiren in the Evaluation of Proteinuria in Diabetes


Captopril Prevention Project


Heart Outcomes Prevention Evaluation


Microalbuminuria, Cardiovascular and Renal Outcomes


Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial


Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

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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

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