December 1991

A Perspective on Converting Enzyme Inhibitors and Calcium Channel Antagonists in Diabetic Renal Disease

Author Affiliations

From the Department of Internal Medicine, Section on Cardiology (Dr Valentino), and the Department of Nephrology (Dr Bakris), Ochsner Medical Institutions, New Orleans, La (Dr Valentino); the Department of Pharmacy, Philadelphia College of Pharmacy, Philadelphia, Pa (Dr Wilson); and the Department of Family Medicine, Medical College of South Carolina, Charleston (Dr Weart). Dr Bakris is now with the Division of Nephrology, University of Texas Health Science Center, San Antonio.

Arch Intern Med. 1991;151(12):2367-2372. doi:10.1001/archinte.1991.00400120013003

Hypertension and renal disease are major causes of morbidity and mortality in the diabetic population, with the presence of microalbuminuria established as a predictor of excess mortality. Numerous attempts, both pharmacologic and nonpharmacologic, have been made to intervene in the disease process. Experimental and clinical evidence suggests that the converting enzyme inhibitors and, more recently, certain calcium antagonists have beneficial effects on renal function above and beyond those simply due to blood pressure control. These effects are likely attributable to favorable systemic and renal hemodynamic changes as well as to direct cellular effects. However, intervention with these agents in various rat models of diabetes or hypertension is initiated very early. Hence, some of the beneficial renal effects may not be as dramatic in clinical practice because of the more commonly advanced stage seen at the time of intervention. We present an overview of the histologic, renal hemodynamic, and antiproteinuric effects of these agents in the experimental setting, as well as the clinical evidence supporting the use of angiotensin-converting enzyme inhibitors and certain classes of calcium antagonists in diabetic renal disease.

(Arch Intern Med. 1991;151:2367-2372)