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Diabetics Get Kidney Protection From ARBs

By
WebMD Health News
Reviewed by Gary D. Vogin, MD

May 20, 2001 (San Francisco) -- Five million Americans have both type 2 diabetes and high blood pressure, a one-two punch that can seriously damage the kidneys and the heart. Now results from three landmark studies of almost 4,000 diabetic patients suggest that a specific class of blood pressure drugs called angiotensin receptor blockers, or ARBs, can protect kidneys and reduce the need for kidney dialysis or transplant.

Results from all three studies were released Saturday at the annual meeting of the American Society of Hypertension.

Among the findings were the following:

  • A 28% reduction in the risk of kidney failure among diabetics with established kidney disease.
  • A slowing of the progression of kidney disease.
  • A 20% reduction in death.

None of the studies evaluated how well the drugs protect the heart.

Nonetheless, in an impassioned presentation to several thousand high blood pressure experts packed into a hotel ballroom, one of the researchers, Hans-Henrik Parving, MD, DMSc, shouted "I call this victory!" Parving is chief physician at the Steno Diabetes Center in Gentofte, Denmark.

"There is an epidemic of progressive [kidney] disease in the United States, and it is due to type 2 diabetes," says Barry M. Brenner, MD, one of the study authors. "If one lives for 15 years with type 2 diabetes, the number of complications looms very large." Brenner is a professor at Harvard Medical School.

Avapro, a drug marketed by Bristol-Myers Squibb and Sanofi-Sythelabo, was the subject of two linked studies. In the first study, researchers tested the drug's ability to slow the progression of diabetic kidney disease in people who have very early signs of kidney failure. The second study tested Avapro in diabetics with established kidney disease to see if it could prevent progression to kidney failure or death. The drug companies funded the studies.

In both studies, the drug protected the kidneys, says Edmund J. Lewis, MD, who lead the study of more than 1,700 diabetics with established kidney disease. Lewis is a professor at Rush Medical College in Chicago.

The third study evaluated another ARB called Cozaar. Merck is the maker of Cozaar and paid for the study. Brenner, who was the lead investigator of this study, tells WebMD that Cozaar also was effective at slowing kidney disease. This study evaluated more than 1,500 diabetics.

In all three studies, all patients achieved good blood pressure control even if they required additional drugs to do so.

Although the findings for these ARBs are impressive, not everyone is convinced of their superiority. George L. Bakris, MD, a professor at Rush-Presbyterian-St. Luke's Medical Center in Chicago, tells WebMD, "For [kidney] disease it's a slam dunk for the ARBs, but it is not so clear for [heart] disease."

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