However, at the start of the study, the HbA1c values in the lisinopril group were 0.4% less than in the control group and this led to a slightly greater decrease in blood pressure under the ACE inhibitor (3 mm Hg). Open in a separate window Figure 4 Options for blocking the renin-angiotensin system (RAS) through angiotensin receptor blockers (AT1 blockers), ACE inhibitors, and renin inhibitors. multifactorial risk reduction significantly lowered the rate of microvascular complications over a mean follow-up interval of 3.8 years (hazard ratios for different complications varying from 0.27 to 0.45). Over the longer term (13.3 years), this approach also led to a reduction of macrovascular events (HR 0.54 for mortality of all causes, 0.43 for cardiovascular mortality, and Dantrolene 0.41 for cardiovascular events). Conclusions Diabetic retinopathy and microalbuminuria are expressions of microvascular damage. They often appear together and point toward possible future macrovascular events. Multifactorial intervention can lessen the consequences of these pathological conditions. strong class=”kwd-title” Keywords: diabetes mellitus, angiotensin blockade, microalbuminuria, retinopathy, cardiovascular risk Although many type 2 diabetics die as a consequence of macrovascular events, the treatment of microvascular complications such as diabetic retinopathy and nephropathy is very significant in practice, as these conditions impair the quality of life and cause high costs (1). However, different organic manifestations are often diagnosed separately. There is not enough collaboration between the doctors and patients are not treated aggressively enough. In order to avoid vision loss and blindness, the German Society for Diabetes (Deutsche Dantrolene Diabetes Gesellschaft, DDG) recommends in their guidelines the interdisciplinary treatment of diabetic retinopathy and maculopathy by (2) adjusting the blood sugar to a near normal range (see DDG Guideline “The Treatment of Diabetes mellitus type 1” and “Antihyperglycemic Treatment of Diabetes mellitus type 2”) (e1, e2), normalization of blood pressure (see DDG Guideline “Management of Hypertension in patients with Diabetes mellitus”) (e3), ophthalmological therapy. Normal blood pressure ( 140/85 mm Hg), near normal blood sugar (HbA1c 6.5%), as well as the adjustment of lipids (HDL cholesterol 1.1 mmol/L, triglycerides 1.7 mmol/L, total cholesterol 5.0 mmol/L) were important therapeutic pillars in the Steno-2 study. If accompanied by lifestyle modification, they significantly reduced microvascular complications after a mean monitoring period of 3.8 years (figure 1) (3, 4). After 13.3 years, the number of macrovascular events (figure 2) was significantly reduced (4). An increased angiotensin II concentration plays a special role, together with hypertension associated with diabetes and hyperglycemia. Angiotensin II leads to constriction of efferent arterioles in the kidney. It increases the filtration pressure in the glomerular capillaries and effects contraction of glomerular mesangium cells. This results in increased filtration of albumin into urine (e4). Furthermore, angiotensin II increases systemic blood pressure, leading to endothelial dysfunction and glomerular damage. In the retina, the renin-angiotensin system (RAS) is also activated in patients with diabetes. Angiotensin II is especially important for the following reasons (e5, 4): It mediates vascular growth and accelerates or causes development of proliferative retinopathy. Moreover, it increases permeability of retinal capillaries for high molecular substances and supports development of macular edema (e7). Open in a separate window Figure 1 Risk reduction of microvascular changes in the Steno 2 study (3) after 3.8 years on the basis of a standard therapy orientated on the guidelines in comparison to intensified therapy, in patients with type 2 diabetes and microalbuminuria and blood pressure 140/85 mm Hg, near normal blood sugar with an HbA1c 6.5 %, HDL cholesterol 1.1 mmol/L, triglycerides 1.7 mmol/L, and total cholesterol 5.0 mmol/L. OR, Odds Ratio; CI, confidence interval Open in a separate window Figure 2 Cumulative incidence of cardiovascular events and death from cardiovascular causes such as nonfatal stroke, non-fatal myocardial infarction, coronary bypass surgery, percutaneous coronary intervention, revascularization and amputation, in the Steno 2 study (4). Comparison between conventional standard therapy orientated on the guidelines and intensified therapy in patients with type 2 diabetes and microalbuminuria and blood pressure 140/85 mm Hg, near normal blood sugar with HbA1c Dantrolene 6.5%, HDL cholesterol 1.1 mmol/L, triglycerides 1.7 mmol/L, and total cholesterol 5.0 mmol/L. The aim of the Dantrolene present study is to demonstrate the BAD significance of retinopathy and microalbuminuria, as well as the significance of blockade of the activity of angiotensin II, and thus to blaze the trail for multifactorial therapy of microvascular diabetic modifications. Methods Medline was selectively searched for.