Nephrol Dial Transplant (1999) 14: 2568-2570
© 1999 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Dosing angiotensin II blockersbeyond blood pressure
Department of Internal MedicineNephrology, Charité, Humboldt University, Berlin and 1 Department of Internal Medicine, Ruperto Carola University Heidelberg, Heidelberg, Germany
Correspondence and offprint requests to: Harm Peters, MD, Department of Internal MedicineNephrology Charité, Campus Charité-Mitte, Humboldt University, Schumannstraße 2021, D-10117 Berlin, Germany. Email: harm.peters@charite.de
Keywords: angiotensin II; TGF-ß; fibrosis
Antihypertensive treatment and progression of renal disease
It has been well established that at least in proteinuric renal disease, progressive loss of renal function can be effectively diminished, or even prevented, by antihypertensive treatment. This principle has been exemplified by early studies of Danish diabetologists [1,2] who administered beta-blockers, hydralazine and diuretics to patients with type 1 diabetes and nephropathy. The beneficial effect of lowering blood pressure has also been well established in non-diabetic renal disease [3].
More recently, it has also been shown that treatment with angiotensin-converting enzyme (ACE) inhibitors provides benefit with respect to progression which goes beyond lowering of blood pressure. This has been documented both for diabetic [4] and non-diabetic glomerular disease [5,6].
Target blood pressure
Unsatisfactory response to ACE inhibitors
Experimental models of progression: importance of extracellular matrix accumulation
Dose of ACE inhibitor angiotensin receptor blocker and renal damage in experimental models
Preliminary clinical evidence
ACE inhibition, receptor antagonism or a combination of both?
Conclusion
References
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