Réduire l'albuminurie : est-ce un facteur indépendant de diminution du risque cardiovasculaire ?

Clinical studies in diabetic patients with albuminuria or diabetic nephropathy at high cardiovascular risk, with drugs acting on renin-angiotensin system (RAS) : angiotensin-converting-enzyme inhibitors (ACEI), or angiotensin II receptor blockers (ARB), indicate dissociated effects on renal and cardiovascular diseases' prevention and/or progression, independent of blood pressure reduction : renal protective effect with daily low doses, but daily higher doses needed to observe a cardiovascular protective effect. These trials support that a strong RAS blockade is needed to achieve not only a renal protective effect but also a cardiovascular preventive/protective effect. Therefore, use of a daily high dose is recommended, either with an ACEI or an ARB, and is preferable to the association of daily low dose of these two therapeutic classes.