Angiotensin receptor blockade in diabetic renal disease—Focus on candesartan

Prevention and regression of diabetic renal disease can be obtained through the combination of strict blood pressure control, which frequently requires the combination of different antihypertensive drugs, with tight glycaemic control. Recent evidence obtained with the angiotensin receptor blockers has allowed the recognition by most guidelines that this class of agents constitutes the first choice to treat hypertension in type 2 diabetic patients presenting with diabetic renal disease at any stage of evolution, from microalbuminuria to advanced renal failure. Of course this must be accompanied by an integral coverture of the increased global cardiovascular risk that always accompanies this situation. This short review contains the most relevant evidence in favour of angiotensin receptor blockers, with particular emphasis on the capacities of candesartan for controlling blood pressure and protecting the kidney. In patients with type 2 diabetes and varying degrees of albuminuria, treatment with candesartan 8–32 mg daily was shown to reduce urinary albumin excretion (UAE) by up to 60%. When given in addition to an ACE inhibitor (dual blockade), reductions in UAE of 25–35% relative to ACE inhibitor monotherapy have been found.