Cor Vasa 2002, 43(10):433-436
Angiotensin II receptor blockers and the kidney
- II. interní klinika, Fakultní nemocnice u sv. Anny, Brno, Česká republika
This topical paper discusses details and differences in the effects of AII blockers and ACE inhibitors on the kidney. Specific AT1 receptor blockade has a beneficial effect by two mechanisms, by inhibiting the effect of angiotensin II on receptor 1, and by stimulating receptor 2 with the same agent (so-called yin-yang effect). In experiments, both ACE inhibitors and AII antagonists have been shown to possess a nephroprotective effect. In patients with microalbuminuria, and with diabetic microalbuminuria in particular, both classes of drugs have been able to reduce the amount of urinary protein. A decrease in the glomerular filtration rate has occasionally been reported with ACE inhibitors, an effect not seen after AII blockers.
Large clinical trials in heart failure (ELITE, ELITE II, Val HeFT) have not demonstrated a difference between ACE inhibitors and AII antagonists on potassium and creatinine levels; large clinical trials in hypertension (LIFE, SCOPE) have confirmed a beneficial action by AII antagonists on the kidney, particularly on reducing proteinuria.
Four large clinical trials have demonstrated a nephroprotective effect by AII antagonists (irbesartan, losartan, valsartan) in patients with diabetes mellitus, and/or with hypertension compared with placebo (RENAAL, IRMA), and/or amlodipine (MARVAL, IDNT), a finding which has resulted in extending the indication of AII antagonists to include diabetic nephropathy.
Keywords: AII antagonists; Hypertension; Diabetes mellitus; Renal function
Published: October 1, 2002 Show citation