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If ineffectively controlled, a progressive decline in renal function can result in end-stage renal disease. Patients with diabetic nephropathy are also at greatly increased risk of cardiovascular disease.
Angiotensin-converting enzyme ACE inhibitors display additional renoprotective effects beyond systemic blood pressure lowering, perhaps due to reduction in intraglomerular pressure by inhibition of angiotensin II activity. In type 2 diabetics, ACE inhibitors have variable effects, with some studies showing a reduction in microalbuminuria, prevention of the progression to macroalbuminuria and maintenance of renal function.
Randomised studies have demonstrated that angiotensin II receptor blockers ARBsas well as controlling systemic blood pressure, delay progression of proteinuria in patients with diabetic nephropathy.
Telmisartan has a number of features that may make it particularly suitable for the treatment of diabetic nephropathy. In addition to its long duration of action and almost exclusive faecal excretion, its high lipophilicity should assist in tissue penetration.
Secondary endpoints are annual changes in glomerular filtration rate, serum creatinine and urinary albumin excretion, as well as incidences of end-stage renal disease, cardiovascular events, all-cause mortality and adverse events.
The groundbreaking DETAIL study revealed that telmisartan conferred comparable renoprotection to enalapril and was associated with a low incidence of mortality.Cisco Press is the official publisher for Cisco certification and network technology self-study resources, providing candidates with flexible learning options including books, eBooks, practice tests, video training, simulator software, and value-priced libraries.
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One question so far unanswered about DETAIL, however, is the high dropout rate: Only 82 of patients on telmisartan and 86 of on enalapril completed the study, despite the low rate of.