|
|
|
|
|
|
Renoprotective Effect of Irbesartan in Nephropathy Due to Type 2 Diabetes
This prospective, randomized, double-blind trial compared the effectiveness of the angiotensin-II–receptor blocker irbesartan, the calcium-channel blocker amlodipine, and placebo in slowing the progression of nephropathy and reducing cardiovascular complications in 1715 patients with hypertension and type 2 diabetes. Additional antihypertensive agents were added as needed to control blood pressure. Irbesartan was associated with a risk of renal deterioration or death that was 20 to 23 percent lower than that with placebo or amlodipine.
Blockade of angiotensin type 1 receptors with irbesartan is effective in slowing the progression of nephropathy in patients with hypertension and type 2 diabetes. This effect is independent of the reduction in blood pressure.
Related Editorial
|
|
|
|
Effects of Losartan in Patients with Type 2 Diabetes and Nephropathy
Diabetic nephropathy is the leading cause of end-stage renal disease. This study, conducted at 250 centers in 28 countries, assessed the role of the angiotensin-II–receptor antagonist losartan in 1513 patients with type 2 diabetes and nephropathy. Patients were enrolled in a randomized, placebo-controlled study of losartan in which they continued to receive conventional antihypertensive therapy (excluding angiotensin-converting–enzyme inhibitors) as needed. Losartan conferred significant benefits in terms of renal outcomes and death, with an overall risk reduction of 16 percent.
This study suggests that angiotensin-receptor blockade may delay the onset of end-stage renal disease and ameliorate heart failure in patients with type 2 diabetes.
Related Editorial
|
|
|
|
Effect of Irbesartan on the Development of Diabetic Nephropathy
Although blockade of the renin–angiotensin system slows the progression of microalbuminuria to diabetic nephropathy in patients with type 1 diabetes, similar data have been lacking for patients with type 2 diabetes. A total of 590 hypertensive patients with type 2 diabetes and microalbuminuria — risk factors for diabetic nephropathy — took part in a randomized, double-blind, placebo-controlled study of irbesartan (150 or 300 mg daily) for two years. Significantly fewer patients assigned to irbesartan had progression to nephropathy. The renoprotective effect of irbesartan was independent of its hypotensive effect.
Early interruption of the renin–angiotensin system with angiotensin-receptor blockade slows the progression from microalbuminuria to overt diabetic nephropathy.
Related Editorial
|
|
|
|
Medical Treatment of Neurocysticercosis with Giant Cysts
A complication of infection with the larval form of the pork tapeworm is the development of cysts in the subarachnoid space. This report describes 33 patients with large cysts and evidence of increased intracranial pressure. All received dexamethasone and a four-week course of albendazole; many required additional courses of treatment. After 59 months of follow-up, all patients had improved.
For patients with neurocysticercosis and intracranial hypertension, neurosurgery has been the treatment of choice. This report shows that some patients respond to intensive medical treatment, although nearly half required placement of a ventriculoperitoneal shunt.
|
|
|
|
Clinical Practice: Essential Tremor
A 66-year-old woman presents with a two-year history of worsening hand tremor. The tremor interferes with activities such as eating and writing and causes her embarrassment. How should she be evaluated and treated?
|
|
|
|
Medical Progress: Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease
The purpose of cardiac rehabilitation is not only to prevent disability in patients with cardiovascular disease but also to modify risk factors in order to prevent subsequent cardiovascular events. Interventions include prescribed exercise, cessation of smoking, dietary modification, and lipid-reduction therapy. This article provides an up-to-date review of the evidence that these interventions are effective in patients with established cardiovascular disease.
|
