Back to Journals » Vascular Health and Risk Management » Volume 5

Choice of ACE inhibitor combinations in hypertensive patients with type 2 diabetes: update after recent clinical trials

Authors Gianpaolo Reboldi, Giorgio Gentile, Fabio Angeli, Paolo Verdecchia

Published 8 May 2009 Volume 2009:5 Pages 411—427

DOI https://doi.org/10.2147/VHRM.S4235

Review by Single-blind

Peer reviewer comments 4

Gianpaolo Reboldi1, Giorgio Gentile1, Fabio Angeli2, Paolo Verdecchia2

1Department of Internal Medicine. University of Perugia, Italy; 2Department of Cardiology, Clinical Research Unit ‘Preventive Cardiology’ Hospital ‘Santa Maria della Misericordia’, Perugia, Italy

Abstract: The diabetes epidemic continues to grow unabated, with a staggering toll in micro- and macrovascular complications, disability, and death. Diabetes causes a two- to four-fold increase in the risk of cardiovascular disease, and represents the first cause of dialysis treatment both in the UK and the US. Concomitant hypertension doubles total mortality and stroke risk, triples the risk of coronary heart disease and significantly hastens the progression of microvascular complications, including diabetic nephropathy. Therefore, blood pressure reduction is of particular importance in preventing cardiovascular and renal outcomes. Successful antihypertensive treatment will often require a combination therapy, either with separate drugs or with fixed-dose combinations. Angiotensin converting enzyme (ACE) inhibitor plus diuretic combination therapy improves blood pressure control, counterbalances renin-angiotensin system activation due to diuretic therapy and reduces the risk of electrolyte alterations, obtaining at the same time synergistic antiproteinuric effects. ACE inhibitor plus calcium channel blocker provides a significant additive effect on blood pressure reduction, may have favorable metabolic effects and synergistically reduce proteinuria and the rate of decline in glomerular filtration rate, as evidenced by the GUARD trial. Finally, the recently published ACCOMPLISH trial showed that an ACE inhibitor/calcium channel blocker combination may be particularly useful in reducing cardiovascular outcomes in high-risk patients. The present review will focus on different ACE inhibitor combinations in the treatment of patients with type 2 diabetes mellitus and hypertension, in the light of recent clinical trials, including GUARD and ACCOMPLISH.

Keywords: type 2 diabetes, blood pressure, ACE inhibitor

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

Current perspectives in stem cell research for knee cartilage repair

Orth P, Rey-Rico A, Venkatesan JK, Madry H, Cucchiarini M

Stem Cells and Cloning: Advances and Applications 2014, 7:1-17

Published Date: 16 January 2014

Cross-linked acrylic hydrogel for the controlled delivery of hydrophobic drugs in cancer therapy

Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS

International Journal of Nanomedicine 2012, 7:4077-4088

Published Date: 27 July 2012

Biomarkers for osteoarthritis: investigation, identification, and prognosis

Zhai G, Aref Eshghi E

Current Biomarker Findings 2012, 2:19-28

Published Date: 29 June 2012

Topical diclofenac in the treatment of osteoarthritis of the knee

Niklas Schuelert, Fiona A Russell, Jason J McDougall

Orthopedic Research and Reviews 2011, 3:1-8

Published Date: 6 February 2011