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The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) study is a multinational, double-blind, randomized, placebo controlled trial which was recently published.
We performed a post hoc analysis in patients with type 2 diabetes participating in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study.
The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) study is a multinational, double-blind, randomized, placebo controlled trial which was recently published [ 1].
In the Reduction of Endpoints in Non-Insulin-Dependent Diabetes with the Angiotensin II Antagonist Losartan (RENAAL) trial, 1,513 patients with diabetic nephropathy were randomly assigned to receive either losartan or placebo in addition to conventional antihypertensive therapy.
In the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan Study (RENAAL)/Irbesartan Diabetic Nephropathy Trial (IDNT) data set the conventional treatment arm was also analyzed.
We used data from the combined Reduction of Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) and Irbesartan Diabetic Nephropathy Trial (IDNT) studies.
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The ADVANCE trial, although not finding a reduction of macrovascular endpoints, could show a reduction of diabetic nephropathy [ 8].
Reverse remodeling, however, is the prerequisite for reduction of hard endpoints such as heart failure hospitalization and mortality [ 7].
Due to the limited numbers of patients, however, it is not clear whether those interventions result in the reduction of clinical endpoints.
These were related to bone fractures, heart failure and gastrointestinal bleeding, whereas the intended primary reduction of CV endpoints could not be substantiated.
The reduction of ischemic endpoints is modest and counterbalanced by an increase in major bleeding, no matter the final management strategy with or without PCI.
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