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• W2023842021 abstract "The first part of this manuscript offers an overview of clinical data supporting the use of renin-angiotensin system (RAS) inhibitors in every patient with type 1 or type 2 diabetes, based on the known role of the RAS in blood pressure regulation and organ protection. In the second part, a possible, relevant role of drugs other than RAS-active compounds in treating hypertension and preventing cardiovascular disease in type 2 diabetic patients is underlined, paying particular attention to calcium-channel blockers, either alone or, better, in combination with ACE inhibitors.The guidelines of the European Society of Hypertension and the European Society of Cardiology recognize that the first monotherapy to be given to a diabetic patient with elevated blood pressure is an RAS suppressor, either an ACE inhibitor or an angiotensin receptor blocker (ARB) when micro- or macroalbuminuria are present (1). They also recognize that in order to lower blood pressure, all effective and well tolerated drugs can be used. Having admitted the possibility of non-RAS suppression therapies as first line, the guidelines continue by saying that the great majority of diabetic patients will sooner or later present hypertension and that most of them will require combination therapy. In this case, they specify that a blocker of the RAS should be a regular component of the combination and the one preferred when monotherapy is sufficient. In summary, an RAS blocker should be used when an elevation of blood pressure, even within the high normal range, is detected.The recent reappraisal of European Society of Hypertension Guidelines (2) confirms that initiation of therapy in the high normal range is reserved for diabetic patients with some degree of target organ damage (TOD), in particular microalbuminuria.Are the guidelines wrong? Probably not, because RAS suppression has three different aspects:1. Capacity to control blood pressure alone …" @default.
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• W2023842021 date "2011-04-22" @default.
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• W2023842021 title "RAS Blockade for Every Diabetic Patient: Pro and Con" @default.
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• W2023842021 doi "https://doi.org/10.2337/dc11-s248" @default.
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