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Antihypertensive Therapy in Diabetes: The Legacy Effect and RAAS Blockade

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Abstract

Two recently published post-monitoring follow-up studies of the United Kingdom Prospective Diabetes Study (UKPDS) have shown that although early and intensive treatment of hyperglycemia provides benefits for cardiovascular mortality that extend over time, the effects of a tight antihypertensive strategy in patients with diabetes did not seem to last during the following years. The authors concluded that blood pressure control is of crucial importance in patients with diabetes but is not protective against cardiovascular events when it is not sustained. Several lines of evidence suggest, however, that early and intensive antihypertensive treatment with some classes of drugs exerts benefits that may persist during the following years. Particularly, blockade of the renin-angiotensin-aldosterone system (RAAS) may interrupt the molecular and cellular mechanisms underlying cardiac and vascular remodeling and the maintenance of high blood pressure values. This review article critically discusses current evidence and explores the rationale for a legacy effect of RAAS blockade in hypertensive patients with diabetes.

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Disclosure

Conflicts of Interest: M. Volpe: active research grant from Novartis; participation in international advisory boards of Bayer Schering Pharma and Daiichi-Sankyo; honoraria for lectures in symposia by Daiichi-Sankyo and Sanofi-Aventis; F. Cosentino: participation in international advisory board of Roche; honoraria for lectures in symposia by Bristol-Myers Squibb and Astra Zeneca; G. Tocci: none; F. Palano: none; F. Paneni: none.

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  1. Division of Cardiology, II Faculty of Medicine, University of Rome “Sapienza”, Sant’Andrea Hospital, Via di Grottarossa, 1035–9, 00189, Rome, Italy

    Massimo Volpe, Francesco Cosentino, Giuliano Tocci, Francesca Palano & Francesco Paneni

  2. IRCCS Neuromed, Polo Molisano, University of Rome “Sapienza”, Pozzilli, Italy

    Massimo Volpe

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  1. Massimo Volpe
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Correspondence to Massimo Volpe.

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Volpe, M., Cosentino, F., Tocci, G. et al. Antihypertensive Therapy in Diabetes: The Legacy Effect and RAAS Blockade. Curr Hypertens Rep 13, 318–324 (2011). https://doi.org/10.1007/s11906-011-0205-z

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