tailieunhanh - Diabetes Chronic Complications - part 3

Hiện đã có một số cuộc tranh luận liệu một ARB hoặc ACEI nên được sử dụng như dòng đầu tiên điều trị cho RAS phong tỏa ở những bệnh nhân bị bệnh tiểu đường type 2. Hai nghiên cứu gần đây đã tăng cường các trường hợp sử dụng cho ACEI | PREVENTION AND TREATMENT OF DIABETIC RENAL DISEASE 39 There has been some debate as to whether an ARB or an ACEI should be used as first line therapy for RAS blockade in patients with type 2 diabetes. Two recent trials have strengthened the case for ACEI use. In the BENEDICT Bergamo Nephrologic Diabetes Complication trial the use of the ACEI trandolapril attenuated the progression from normoalbuminuria to microalbuminuria in subects with type 2 diabetes and hypertension. The unique protective effects of RAS blockade in hypertensive patients was emphasized as the calcium channel blocker verapamil did not prevent the onset of An ACEI enalapril has also been demonstrated to provide equivalent long-term renoprotection compared to the ARB telmisartan as measured by a decline in GFR in hypertensive patients with type 2 diabetes and early Both ARBs and ACEI use may prove to have equivalent beneficial effects as first-line therapy in subjects with type 2 daibetes but the question as to which agent to use may to some extent be academic as many patients will possibly end up being treated with the early introduction of both agents. Dual blockade of the RAS with an ACEI and ARB in subjects with type 2 diabetes and microalbuminuria has been demonstrated to be more effective in reducing blood pressure and decreasing albuminuria than either agent as In macroalbuminuric patients with type 1 and type 2 diabetes the addition of an ARB to ACEI therapy has been reported to provide superior renoprotection in terms of reducing albuminuria compared with maximal recommended doses of an ACEI in type 1 and type 2 diabetes. Whether the effects of dual therapy with an ACEI and an ARB will ultimately translate to a reduced incidence of ESRD in patients with diabetes is unknown. However the recent COOPERATE study from Japan demonstrated that dual therapy in non-diabetic proteinuric patients was superior to monotherapy in retarding progression to