The Role of Angiotensin Receptor Blockers in Diabetic Nephropathy

Background: Hypertension and diabetes are common risk factors for nephropathy as well as for neuropathy, retinopathy, cardiovascular disease, and cerebrovascular disease. Diabetic nephropathy occurs in 20% to 40% of patients with type 2 diabetes mellitus and is the single most important cause of end-stage renal disease (ESRD) worldwide, accounting for 40% to 45% of new cases in the United States. The incidence of ESRD is predicted to increase as the prevalence of type 2 diabetes mellitus and obesity continue to increase. Methods: Clinical data from the recent classes of antihypertensive agents are reviewed in the context of hypertension reduction guidelines and prevention of diabetic nephropathy. Results: Numerous clinical trials have demonstrated that angiotensin receptor blockers (ARBs) are safe and effective antihypertensive treatments that slow the progression of renal disease in people with diabetes and/or hypertension, and macroalbuminuria. Conclusion: The tolerable adverse event profile of ARBs and their renoprotective benefits beyond blood pressure reduction make ARBs a useful first-line treatment in people with, or at risk of developing, renal disease. As the incidence of obesity-related cardiovascular disease and renal risk factors continues to grow, future studies are required to directly assess the renoprotective effects of ARBs in overweight or obese patient subgroups. Because renin angiotensin system (RAS) inhibitors target the key mechanisms underlying these conditions, they may be particularly beneficial for the prevention of ESRD in the growing group of patients with obesity-related hypertension and the metabolic syndrome.