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Review: ACE inhibitors, but not angiotensin II receptor antagonists, reduce all cause mortality in diabetic nephropathy

Clinical impact ratings GP/FP/Primary care IM/Ambulatory care Internal medicine Nephrology Endocrine

Key Words: angiotensin converting enzyme inhibitors • diabetes mellitus (type II) • diabetic nephropathies

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline (1966 to September 2003), EMBASE/Excerpta Medica (1988 to September 2003), the Cochrane Library, conference proceedings, and contact with experts.

Study selection and assessment: randomised controlled trials (RCTs) in any language of 6 months’ duration comparing ACE inhibitors or AIIRAs with placebo, no treatment, or each other in patients with any stage of diabetic nephropathy. Studies were assessed for methodological quality.

Outcomes: all cause mortality and renal outcomes.

MAIN RESULTS
43 RCTs (follow up range 6–96 mo) met the selection criteria; 36 (4008 patients) compared ACE inhibitors with placebo or no treatment, 4 (3331 patients) compared AIIRAs with placebo or no treatment, and 3 (206 patients) compared ACE inhibitors with AIIRAs. ACE inhibitors, but not AIIRAs, reduced all cause mortality more than placebo or no treatment (table). The table shows the effects of ACE inhibitors and AIIRAs on renal outcomes. ACE inhibitors did not differ from placebo or no . . . [Full text of this article]

Edgar V Lerma, MD, FACP, FASN

University of Illinois at Chicago College of Medicine/ Associates in
Nephrology, SC
Chicago, Illinois, USA