From the Guidelines
To reduce end organ damage, controlling underlying conditions like hypertension, diabetes, and kidney disease through medication and lifestyle changes is crucial, with a focus on maintaining blood pressure below 130/80 mmHg and HbA1c below 7%. For hypertension, medications such as ACE inhibitors (like lisinopril 10-40mg daily), ARBs (such as losartan 25-100mg daily), calcium channel blockers, and diuretics can be effective, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. Lifestyle modifications are equally important, including maintaining a healthy weight, following a low-sodium diet (less than 2300mg daily), exercising regularly (150 minutes of moderate activity weekly), avoiding smoking and excessive alcohol, and managing stress.
Regular monitoring of organ function through blood tests (creatinine, liver enzymes, lipid panels) and specialized tests (echocardiograms, eye exams) is essential to prevent progressive damage to the heart, kidneys, brain, and other organs. The 2007 guidelines for the management of arterial hypertension also emphasize the importance of lifestyle modifications, such as a low-caloric diet and physical exercise, in reducing the risk of cardiovascular disease and diabetes 1. Additionally, the national kidney foundation practice guidelines for chronic kidney disease highlight the importance of early detection and treatment of chronic kidney disease to prevent adverse outcomes, including cardiovascular disease 1.
Key interventions include:
- Controlling blood pressure and blood glucose levels
- Maintaining a healthy weight and diet
- Exercising regularly and avoiding harmful substances
- Regular monitoring of organ function
- Using medications such as ACE inhibitors, ARBs, and metformin as needed, with consideration of the most recent guidelines and evidence-based practices.
From the FDA Drug Label
- 4 Increases in HbA1c and Fasting Serum Glucose Levels
Increases in HbA1c and fasting serum glucose levels have been reported with statins, including atorvastatin. Optimize lifestyle measures, including regular exercise, maintaining a healthy body weight, and making healthy food choices.
To reduce end organ damage, optimize lifestyle measures such as:
- Regular exercise
- Maintaining a healthy body weight
- Making healthy food choices 2
From the Research
Reducing End Organ Damage
To reduce end organ damage, several therapeutic approaches can be taken, including:
- The use of antihypertensive agents such as diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin II (Ang II) receptor antagonists, beta-blockers, or calcium channel blockers (CCBs) which have been shown to reduce effectively hypertension associated cardiovascular events and to improve end organ damage 3
- Angiotensin receptor blockers (ARBs) which have been established to prevent adverse cardiovascular and renal outcomes in patients with diabetes mellitus, and have an improved safety profile compared to ACE inhibitors 4, 5
- ACE inhibitors which have been shown to reduce both microvascular and macrovascular complications in diabetes and appear to improve insulin sensitivity and glucose metabolism 6
- Mineralocorticoid receptor blockers or selective sodium-glucose cotransporter type 2 inhibitors which may further protect patients with diabetes from cardiovascular and renal complications 4
Therapeutic Agents
The choice of therapeutic agent may depend on the specific patient population and comorbidities, such as:
- ACE inhibitors which are particularly indicated for managing patients with congestive heart failure due to systolic dysfunction and patients with diabetic nephropathy 7
- Angiotensin II receptor antagonists which may be equally effective as ACE inhibitors for these indications 7
- Calcium antagonists which are effective in managing hypertension induced by cyclosporine and isolated systolic hypertension in the elderly 7
Mechanisms of Action
The mechanisms by which these therapeutic agents reduce end organ damage include: