ACE Inhibition, Angiotensin II Receptor Blockade, and Diabetic Nephropathy

Abstract

Only a large, rigorous randomized double-blind assessment of a therapeutic candidate compared to the appropriate alternative can prove therapeutic efficacy. One such trial assessed the effect of Captopril in patients with insulin-dependent diabetes mellitus (IDDM) who were at risk of nephropathy [1], with results that were sufficiently impressive that the use of Captopril quickly became a professional necessity supported by public policy. Moreover, multiple lines of evidence accumulated over a decade suggested that this useful feature of Captopril was a class action, extending to all ACE inhibitors. [2,3] In the case of the angiotensin II (Ang II) AT₁ receptor blockers (AT₁ antagonists), we are fortunate in having very early in the development of these agents two ongoing major, high quality trials in patients with NUDDM who are at risk of nephropathy — one involving Irbesartan, the other involving Losartan. Unfortunately, the outcome of these trials is unlikely to be available to us until the coming millennium, and this chapter is due well before!