Angiotensin-Receptor Blockers for Renal Protection in Type 2 Diabetes

Diabetic nephropathy is the single most frequent cause of end-stage renal disease worldwide. Diabetic nephropathy is characterized by proteinuria, gradual loss of renal function, hypertension and increased cardiovascular risk. In Type 2 diabetes mellitus, the disease is often detected when nephropathy has already progressed to advanced stages that only marginally benefit from renoprotective treatments. Thus, screening programs are needed to detect diabetic nephropathy and initiate treatment before progression becomes irreversible. The renin–angiotensin system is often activated in diabetic nephropathy and may contribute to the progression of renal injury through a variety of mechanisms largely mediated by the angiotensin type 1 receptor. Renin–angiotensin system inhibition, in particular by angiotensin-receptor blockers, may have specific cardiovascular and renoprotective effects that are at least in part independent of blood pressure reduction, and may also improve several features of the metabolic syndrome that almost invariably accompany the disease. Whether combined therapy with angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers may offer additional benefits compared with angiotensin-receptor blocker therapy alone is still under investigation.