Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro-and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials

Maione, Ausilia, Navaneethan, Sankar D., Graziano, Giusi, Mitchell, Ruth, Johnson, David, Mann, Johannes F. E., Gao, Peggy, Craig, Jonathan C., Tognoni, Giovanni, Perkovic, Vlado, Nicolucci, Antonio, De Cosmo, Salvatore, Sasso, Antonio, Lamacchia, Olga, Cignarelli, Mauro, Manfreda, Valeria Maria, Gentile, Giorgio and Strippoli, Giovanni F. M. (2011) Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro-and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials. Nephrology Dialysis Transplantation, 26 9: 2827-2847. doi:10.1093/ndt/gfq792


Author Maione, Ausilia
Navaneethan, Sankar D.
Graziano, Giusi
Mitchell, Ruth
Johnson, David
Mann, Johannes F. E.
Gao, Peggy
Craig, Jonathan C.
Tognoni, Giovanni
Perkovic, Vlado
Nicolucci, Antonio
De Cosmo, Salvatore
Sasso, Antonio
Lamacchia, Olga
Cignarelli, Mauro
Manfreda, Valeria Maria
Gentile, Giorgio
Strippoli, Giovanni F. M.
Title Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro-and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
1460-2385
Publication date 2011-01-01
Sub-type Article (original research)
DOI 10.1093/ndt/gfq792
Volume 26
Issue 9
Start page 2827
End page 2847
Total pages 21
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Formatted abstract
Background. A recent clinical trial showed harmful renal effects with the combined use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) in people with diabetes or vascular disease. We examined the benefits and risks of these agents in people with albuminuria and one or more cardiovascular risk factors.

Methods. MEDLINE, EMBASE and Renal Health Library were searched for trials comparing ACEI, ARB or their combination with placebo or with one another in people with albuminuria and one or more cardiovascular risk factor.

Results. Eighty-five trials (21 708 patients) were included. There was no significant reduction in the risk of all-cause mortality or fatal cardiac–cerebrovascular outcomes with ACEI versus placebo, ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. There was a significant reduction in the risk of nonfatal cardiovascular events with ACEI versus placebo but not with ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. Development of end-stage kidney disease and progression of microalbuminuria to macroalbuminuria were reduced significantly with ACEI versus placebo and ARB versus placebo but not with combined therapy with ACEI + ARB versus monotherapy.

Conclusions. ACEI and ARB exert independent renal and nonfatal cardiovascular benefits while their effects on mortality and fatal cardiovascular disease are uncertain. There is a lack of evidence to support the use of combination therapy. A comparative clinical trial with ACE, ARB and its combination in people with albuminuria and a cardiovascular risk factor is warranted.
Keyword Angiotensin receptor blockers
Angiotensin-converting enzyme inhibitors
Macroalbuminuria
Microalbuminuria
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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