Positive effects of angiotensin [correctedreceptor blockers on the course of microvascular complications of diabetes mellitus

The aim of the research was to evaluate some clinical and hemodynamic characteristics in patients with diabetes mellitus type 1 and type 2 (DM type 1 and DM type 2), to diagnose diabetic retinopathy (DR) on early stage of its development for the correction of the disease by treating with angiotensin II type 1 receptor blocker (AT I)--Candesartan. Totally 250 patients (pts) with DM type 1 and DM type 2 were studied; they were divided into 3 groups (Gr.): Gr.1 (n=115)--pts with DM and without DR; Gr. 2 (n=43)--pts with DM type 1 and DR; Gr.3 (n=92)--pts with DM type 2 and DR. A comprehensive physical examination was conducted to obtain baseline information about the patient: clinical status, lipid profile, microalbuminuria and urine creatinine, as well as glycemia levels. Patients were treated with Candesartan (16 or 32 mg) or placebo. When necessary, other antihypertensive agents (except ACE-inhibitors) were initiated. Eye fundus monitoring was performed with evaluation of 7,300 standard zone stereoscopic pictures of the retina according to ETDRS (Early Treatment of Diabetic Retinopathy Study). The results of three year observation revealed no pathologic changes on the retina in normotensive and normoglycemic pts; pts with mild diabetic retinopathy at baseline demonstrated normal levels of ABP and blood glucose which resulted in the regression of the changes. The changes of various severity demonstrated no positive shifts in 96% of cases; DR deterioration (proliferative DR, neovascularisation stage) was observed in 4% of cases. Results of the study showed that Candesartan treatment of pts with DM resulted in positive shifts in the pathologic changes, registered on the retina and decrease in urine albumin excretion rate. Thus, we recommend to include Candesartan in the standard treatment, as the have positive effect on the course microvascular complications of diabetes mellitus both in males and females.