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ACE Inhibitors: Use Them Early and Often

KEY POINT

Practitioners tend to think of using ACE inhibitors in patients with diabetes only when kidney function begins to decline. But an accumulating body of evidence points to the benefits of using these agents much earlier and more aggressively.

SOURCES

Golan L et al. The cost-effectiveness of treating all patients with type 2 diabetes with angiotensin-converting enzyme inhibitors. Ann Intern Med. 1999;131: 660–7.

Ritz E et al. End-stage renal failure in type 2 diabetes: a medical catastrophe of worldwide dimensions. Am J Kidney Dis. 1999;34:795–808.

Lewis JB et al. Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Am J Kidney Dis. 1999;34:809–17.

Sharma K et al. Captopril-induced reduction of serum levels of transforming growth factor-B1 correlates with long-term renoprotection in insulin-dependent diabetic patients. Am J Kidney Dis. 1999;34:818–23.

Remuzzi G. Renoprotective effect of ACE inhibitors: dissecting the molecular clues and expanding the blood pressure goal [editorial]. Am J Kidney Dis. 1999;34:951–4.