Exp Clin Endocrinol Diabetes 2016; 124(06): 350-360
DOI: 10.1055/s-0035-1550017
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Dark Side of Blocking RAS in Diabetic Patients with Incipient or Manifested Nephropathy

D. Bolignano
1   CNR – Institute of Clinical Physiology, Reggio Calabria, Italy
,
A. Pisano
1   CNR – Institute of Clinical Physiology, Reggio Calabria, Italy
,
G. Coppolino
2   Nephrology and Dialysis Unit, University Hospital of Catanzaro, Italy
› Author Affiliations
Further Information

Publication History

received 19 March 2015
first decision 19 March 2015

accepted 05 May 2015

Publication Date:
11 June 2015 (online)

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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

Next part of this series:

Hypertension and Diabetic NephropathyExp Clin Endocrinol Diabetes 2016; 124(06): 333-334
DOI: 10.1055/s-0042-110231

 

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