Document Detail


Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis.
MedLine Citation:
PMID:  17367311     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta-analysis of studies investigating combination therapy for DN. METHODS: Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24-h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points. RESULTS: In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8-12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32-0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 micromol/l 95% CI -0.76-13.73; P = 0.09). Potassium was increased by 0.2 (0.08-0.32) mmol/l (P < 0.01) with ACEI + ARB. Systolic and diastolic blood pressure were reduced by 5.2 (2.1-8.4) mmHg (P < 0.01) and 5.3 (2.2-8.4) mmHg (P < 0.01), respectively. CONCLUSIONS: This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure. These results should be interpreted cautiously as most of the included studies were of short duration and the few long-term studies (12 months) have not demonstrated benefit.
Authors:
D L Jennings; J S Kalus; C I Coleman; C Manierski; J Yee
Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2007-03-15
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  24     ISSN:  0742-3071     ISO Abbreviation:  Diabet. Med.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-01     Completed Date:  2007-09-26     Revised Date:  2007-10-09    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  486-93     Citation Subset:  IM    
Affiliation:
Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Diabetic Nephropathies / complications,  drug therapy*
Drug Therapy, Combination
Female
Humans
Kidney Diseases / etiology,  prevention & control*
Male
Middle Aged
Receptors, Angiotensin / antagonists & inhibitors*,  therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Receptors, Angiotensin
Comments/Corrections
Comment In:
Nat Clin Pract Nephrol. 2007 Oct;3(10):532-3   [PMID:  17768409 ]

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