Aliskiren combined with losartan in type 2 diabetes and nephropathy
AVOID Study Investigators (Including: Parving, Hans-Henrik, Persson, Frederik, Lewis, Julia B., Lewis, Edmund J. and Hollenberg, Norman K.). (2008) Aliskiren combined with losartan in type 2 diabetes and nephropathy. New England Journal Of Medicine , Vol.358 (No.23). pp. 2433-2446. ISSN 0028-4793Full text not available from this repository.
Official URL: http://dx.doi.org/10.1056/NEJMoa0708379
The pathogenesis of diabetic nephropathy is multifactorial, and the renin−angiotensin−aldosterone system plays an important role.1,2 Persistent proteinuria is the hallmark of diabetic nephropathy, a condition that is characterized by a progressive rise in blood pressure, a declining glomerular filtration rate, and a high risk of fatal or nonfatal cardiovascular events. The degree of proteinuria is closely associated with the rates of renal and cardiovascular events.3,4 Furthermore, a reduction in proteinuria is associated with a slowing of both the decline in the glomerular filtration rate5 and the progression to end-stage renal disease.6 In addition, decreasing proteinuria is associated with improved cardiovascular outcomes in patients with diabetic nephropathy7 and arterial hypertension.8 As a result, a reduction in proteinuria has been widely used as a surrogate end point for renoprotection.
During the past two decades, the outlook for patients with diabetes who have microalbuminuria or macroalbuminuria has improved, probably owing to early aggressive lowering of blood pressure and blocking of the renin−angiotensin−aldosterone system.3,4,9-12 However, there is still a large, unmet need to develop strategies for the prevention of diabetic nephropathy and its progression to end-stage renal disease. Diabetic nephropathy remains the leading cause of end-stage renal disease in the developed world.
The aim of this trial was to evaluate the potential renoprotective capacity of direct renin inhibition with aliskiren in patients with hypertension, type 2 diabetes, and proteinuria who were already receiving the maximal recommended renoprotective treatment with losartan (100 mg daily) and optimal treatment for hypertension. In addition, the safety of dual blockade of the renin−angiotensin−aldosterone system was monitored and recorded.
|Item Type:||Journal Article|
|Subjects:||R Medicine > R Medicine (General)|
|Divisions:||Faculty of Medicine > Warwick Medical School > Metabolic and Vascular Health
Faculty of Medicine > Warwick Medical School
|Journal or Publication Title:||New England Journal Of Medicine|
|Publisher:||Massachusetts Medical Society|
|Date:||5 June 2008|
|Page Range:||pp. 2433-2446|
|Access rights to Published version:||Restricted or Subscription Access|
Actions (login required)