The Use Of Antihypertensive Agents In Dm Patients

The choice of an antihypertensive agent in the management of abnormal albuminuria in DM2 depends not only on its potential renoprotective effect but must also take into consideration other factors, which could be deleterious to the patient. Microalbuminuria in the DM2 patient is more closely linked to subsequent death from cardiovascular disease than from nephropathy [75-78], although this association has not been substantiated in all populations [77, 79]. It has also been shown that rapid progression of albuminuria is an independent predictor of cardiovascular mortality in DM2 with microalbuminuira [80]. Therefore it is important that any antihypertensive intervention in the DM2 patient, especially those with albuminuria does not exacerbate existing lipid abnormalities such as further reducing HDL-cholesterol [81]. Furthermore, reduced sensitivity to insulin after administration of thiazides and various beta-blockers may be detrimental [82]. However, subsequent studies suggest that low dose diuretics do not have deleterious effects on plasma glucose or lipid levels [83]. In contrast, improved insulin sensitivity is seen after captopril and other ACEI [82, 84, 85], doxazocin [82, 84-86] and minimal or neutral effects are observed with CCB [87]. The effect of CCB may be dependent on the duration of action. The short-acting CCB tend to have a detrimental effect, whereas the long-acting CCB improve insulin sensitivity [85]. Also, in contrast to beta-blockers and thiazide diuretics, neither CCB nor ACEI affect glucose tolerance deleteriously [87]. The effects of the AII receptor antagonists such as losartan and candesartan have not been as extensively studied but they appear to have no or a beneficial effect on insulin sensitivity. [84, 85, 88].

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