open access

Vol 8, No 6 (2007): Practical Diabetology
Other materials agreed with the Editors
Published online: 2007-07-03
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Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy - a meta-analysis

D.L. Jennings, J.S. Kalus, C.I. Coleman, C. Manierski, J. Yee
Diabetologia Praktyczna 2007;8(6):219-228.

open access

Vol 8, No 6 (2007): Practical Diabetology
Original articles (translated)
Published online: 2007-07-03

Abstract


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- 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 umol/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) mm Hg (p < 0.01) and 5.3 (2.2-8.4) mm Hg (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

Abstract


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- 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 umol/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) mm Hg (p < 0.01) and 5.3 (2.2-8.4) mm Hg (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
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Keywords

angiotensin-converting enzyme inhibitor; angiotensin-receptor blocker; combination therapy; diabetic nephropathy

About this article
Title

Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy - a meta-analysis

Journal

Clinical Diabetology

Issue

Vol 8, No 6 (2007): Practical Diabetology

Article type

Other materials agreed with the Editors

Pages

219-228

Published online

2007-07-03

Bibliographic record

Diabetologia Praktyczna 2007;8(6):219-228.

Keywords

angiotensin-converting enzyme inhibitor
angiotensin-receptor blocker
combination therapy
diabetic nephropathy

Authors

D.L. Jennings
J.S. Kalus
C.I. Coleman
C. Manierski
J. Yee

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