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[IP] Diabetics Get Kidney Protection From ARBs MUST READ

Original article:

Diabetics Get Kidney Protection From ARBs 
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." 
This is a significant issue because diabetes and high blood pressure are
both separate risk factors for heart disease and stroke. A patient with both
faces double jeopardy. But another class of high blood pressure medications,
called angiotensin-converting enzyme inhibitors, or ACE inhibitors, can
protect the kidneys and reduce the risk of death from heart disease. Until
the release of these new ARB studies, ACE inhibitors have been considered
the drug of choice for treating high blood pressure in diabetics.
Importantly, none of the studies presented Saturday compared the ARBs
against an ACE inhibitor, so it's unknown whether ARBs also can reduce the
risk of death from heart disease. 
Bakris was an investigator in Brenner's study, and he acknowledges that the
study was not designed to evaluate whether Cozaar reduces the risk of heart
disease. However, he tells WebMD that Cozaar did reduce "hospitalization for
heart failure by 32%." 
Parving, who studied nearly 600 people with patients with the earliest stage
of kidney disease -- a condition called microalbuminuria -- says that in his
study when patients were given Avapro, they had about half the number of
heart attacks and strokes as patients who were treated with other blood
pressure drugs. 
Microalbuminuria means that very small amounts of albumin can be detected in
the urine. Brenner says that microalbuminuria happens when "blood vessels in
the kidney start leaking protein, which means the vessels are damaged."
Parving's study evaluated whether Avapro prevented or slowed the progression
of kidney disease from this very early stage. Avapro reduced the risk of
progression by 10%, he tells WebMD. 
One advantage that the ARBs have over ACE inhibitors is that these drugs are
more patient friendly, notes Brenner, who says about one in five patients
will stop taking an ACE inhibitor because the drug often causes a dry,
hacking cough. There is no cough associated with ARBs, he says. 
But the downside of ARBs is cost. Sometimes both an ARB and an ACE-inhibitor
fail to control blood pressure without the help of other drugs. Typically
patients will take two or more blood pressure medicines, says Bakris. "That
means an ACE [inhibitor] or an ARB plus other drugs -- sometimes several
other drugs," he says. 
ARBs cost about 15-25% more than an ACE inhibitor, especially since generic
versions of some ACE inhibitors are available. Since many type 2 diabetics
are covered by Medicare, which doesn't pay for prescription drugs, the price
of adding an expensive drug to an already long list of medications can
create a hardship, says Bakris. 

) 2001 WebMD Corporation. All rights reserved.

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