Prevention de l'apparition du diabete de type 2 par l'inhibition du systeme renine-angiotensine.

Type 2 diabetes mellitus and arterial hypertension are part of the insulin resistance syndrome. Besides a metabolic component, insulin resistance has also an haemodynamic component, especially in relation with an endothelial dysfunction. Some studies suggested that inhibitors of angiotensin converting enzyme can improve insulin sensitivity. Interestingly enough, three clinical trials recently reported concordant results showing that the inhibition of the renin-angiotensin system significantly reduces the risk of developing type 2 diabetes in patients at high risk of vascular complications, essentially with hypertension: the CAPPP trial with captopril (-14%, p = 0.39), the HOPE study with ramipril (-34%, p < 0.001) and the LIFE study with losartan (-25%, p < 0.001). However, these observations could be criticized because such a protective effect was only considered as a secondary endpoint in these studies. Two large prospective, controlled, randomized, double-blind trials are ongoing to specifically confirm this interesting hypothesis, one with ramipril and the other with valsartan.