Angiotensin II antagonists: clinical experience in the treatment of hypertension, prevention of cardiovascular outcomes and renal protection in diabetic nephropathy and proteinuria

Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Objective:

This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.

Methods:

Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.

Results:

Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical and demographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.

Conclusion:

Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery.

Microalbuminuria screening in patients with hypertension: recommendations for clinical practice

INTRODUCTION

Correlations between renal and cardiovascular (CV) pathologies in advanced kidney or heart disease are well characterised, but less clearly defined in the early stages. Microalbuminuria, in addition to being an early sign of kidney damage, is often found in patients with essential hypertension, suggesting that it may reflect early vascular abnormalities.

EVIDENCE FROM LITERATURE

Studies have shown that even very low levels of microalbuminuria strongly correlate with CV risk: albumin excretion rates as low as 4.8 microg/min, well below the microalbuminuria thresholds stated in current clinical guidelines, are associated with increased risk of CV and cerebrovascular disease, independent of the presence of other risk factors. Increased microalbuminuria indicates endothelial dysfunction or developing atherosclerosis and predicts end-organ damage, major cardio or cerebrovascular events and death.

CLINICAL ASPECTS

Available tests for screening microalbuminuria are sensitive, reliable and accessible; current European and US guidelines advocate annual screening in patients with diabetes and wherever possible in non-diabetic patients with hypertension. Early identification of high-risk patients through detection of microalbuminuria allows selection of aggressive treatment to slow disease progression.

THERAPEUTIC IMPLICATIONS

Antihypertensive agents providing angiotensin II blockade are recommended for the treatment of hypertensive patients with microalbuminuria, regardless of diabetes and/or early or overt nephropathy. Treatment with angiotensin II receptor blockers provides effective reduction of microalbuminuria and blood pressure, and long-term prevention of CV events beyond blood pressure reduction. In addition, pharmacoeconomic studies have shown that these long-term benefits translate into a substantially reduced burden on healthcare resources.