Reducing cardiovascular risk:protecting the kidney

Progressive decline of renal function in chronic kidney disease (CKD), measured by a reduced glomerular filtration rate or albuminuria, is linked to an increased risk of cardiovascular (CV) disease. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), most likely because of their blockade of the pathophysiological effects of angiotensin II, provide renoprotection and are the treatment of choice in patients with CKD including those with diabetes. This renoprotective property appears to be partly independent of the blood pressure-lowering effect of drugs that intervene in the renin-angiotensin-aldosterone system. Recent data from the ONTARGET study show that the ARB telmisartan has similar CV and renal protection as the ACE-inhibitor ramipril in patients at risk but is better tolerated. Although extensively used by nephrologists, no additional benefit was observed with the combination of telmisartan plus ramipril compared with ramipril alone on the composite renal endpoint.