Abstract
Renin-angiotensin system (RAS) inhibitors are currently advocated as the first line
approach for diabetic patients with high blood pressure, particularly if early signs
of renal damage are manifest. This mostly relies on the supposed benefits of these
drugs, either achieved indirectly by blood pressure lowering or directly by pleiotropic
effects, on cardiovascular and renal outcomes. Yet, data from large randomized controlled
trials and independent meta-analyses seem to raise some concerns on the compelling
use of RAS-inhibitors in the whole diabetic population as improvements in cardiovascular
and renal endpoints may not be as definite as generally believed. Furthermore, the
risk of adverse events, such as hyperkalemia, deserves more attention in diabetic
patients.
In this brief review we aimed at summarizing the most relevant available evidence
on “negative” or “null” effects of RAS-inhibitors on clinical outcomes in diabetic
patients, providing reasons for a “personalized” rather than generalized use of these
drugs according to individual characteristics.
Key words
renin-angiotensin system - ACE inhibitors - angiotensin-receptor blockers - cardiovascular
disease - diabetes - diabetic nephropathy - direct renin inhibitors - hypertension
