Antihypertensive therapy in diabetes: the legacy effect and RAAS blockade

Curr Hypertens Rep. 2011 Aug;13(4):318-24. doi: 10.1007/s11906-011-0205-z.

Abstract

Two recently published post-monitoring follow-up studies of the United Kingdom Prospective Diabetes Study (UKPDS) have shown that although early and intensive treatment of hyperglycemia provides benefits for cardiovascular mortality that extend over time, the effects of a tight antihypertensive strategy in patients with diabetes did not seem to last during the following years. The authors concluded that blood pressure control is of crucial importance in patients with diabetes but is not protective against cardiovascular events when it is not sustained. Several lines of evidence suggest, however, that early and intensive antihypertensive treatment with some classes of drugs exerts benefits that may persist during the following years. Particularly, blockade of the renin-angiotensin-aldosterone system (RAAS) may interrupt the molecular and cellular mechanisms underlying cardiac and vascular remodeling and the maintenance of high blood pressure values. This review article critically discusses current evidence and explores the rationale for a legacy effect of RAAS blockade in hypertensive patients with diabetes.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects
  • Diabetes Mellitus, Type 2 / pathology*
  • Endothelium, Vascular / drug effects
  • Endothelium, Vascular / pathology
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / pathology
  • Oxidative Stress
  • Renin-Angiotensin System / drug effects*
  • Time Factors

Substances

  • Antihypertensive Agents