The metabolic connection in cardiovascular risk: is there new evidence for the treatment of hypertension, insulin resistance and diabetic nephropathy?

Tuesday 31st August 2004

The metabolic connection in cardiovascular risk: is there new evidence for the treatment of hypertension, insulin resistance and diabetic nephropathy?

Munich, Germany

Metabolic syndrome and diabetes will impose heavy demands on health-care resources in 21st century. This symposium considered the metabolic connection in cardiovascular risk.

Identifying, assessing and treating the metabolic factors that underlie cardiovascular disease are important features of patient care. An extensive range of pharmacological interventions are now available. Among these are the antihypertensive drug classes, which offer distinct approaches to the central goal of reducing blood pressure. Trials of antihypertensive drugs have revealed strong evidence that metabolic differences have important therapeutic implications, and pre-clinical studies are helping to unravel the mechanistic basis for the clinical observations. Presentations at the well-attended symposium highlighted recent developments in antihypertensive treatment in management of patients with type 2 diabetes, a population that is at high risk of cardiovascular disease.

Issues considered were the implications of the cardiovascular disease continuum in diabetic patients, and what new treatment strategies are on the horizon to reduce their heightened cardiovascular risk. Nephropathy is an all too common complication in diabetic patients, many of whom face the prospect of end-stage renal disease. The degree of nephropathy is also a strong marker of cardiovascular risk. Consequently, the impact of different antihypertensive drugs on renal outcomes has been closely examined. A recent, groundbreaking clinical study is Diabetics Exposed to Telmisartan And enalaprIL (DETAIL). For the first time, the long-term renoprotective effects of an angiotensin II receptor blocker and an angiotensin-converting enzyme inhibitor have been compared using glomerular filtration rate to determine kidney function. The rationale and principal findings of DETAIL were presented at the symposium. This was followed by a look at the future prospects for cardiovascular protection in diabetics. Clearly, maximizing the antihypertensive treatment benefit in patients with diabetes is an important target in stemming future health-care demands, as well as improving the prognosis and quality of life of these individuals.

Faculty

Symposium Chairmen

• Eberhard Ritz - Ruprecht Karls University Heidelberg, Heidelberg, Germany
• Massimo Volpe - University of Rome, Rome, Italy

Speakers

• Anthony Barnett - Birmingham Heartlands Hospital, West Midlands, UK
• Willa Hsueh - University of California Los Angeles, Los Angeles, USA
• Theodore W Kurtz - University of California San Francisco, San Francisco, USA

Agenda

• Introduction - Massimo Volpe, Italy
• Cardiovascular risk continuum: implications of insulin resistance and diabetes - Willa Hsueh, USA
• Identification of new treatment strategies for insulin resistance, metabolic syndrome and hypertension - Theodore W Kurtz, USA
• The DETAIL study - ACE or ARB: which is better for renal protection? - Anthony Barnett, UK
• What does the future hold for cardiovascular protection of diabetic patients? - Massimo Volpe, Italy
• Concluding remarks - Eberhard Ritz, Germany

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