Review: ACE inhibitors delay microalbuminuria in diabetes without nephropathy and reduce mortality in diabetic nephropathy

doi:10.1136/ebm.11.5.144

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Evidence-Based Medicine 2006;11:144; doi:10.1136/ebm.11.5.144
Copyright © 2006 by the BMJ Publishing Group Ltd.

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Therapeutics

Review: ACE inhibitors delay microalbuminuria in diabetes without nephropathy and reduce mortality in diabetic nephropathy

Strippoli GF, Craig MC, Schena FP, et al. Role of blood pressure targets and specific antihypertensive agents used to prevent diabetic nephropathy and delay its progression. J Am Soc Nephrol 2006;17:S153–5.[Abstract/Free Full Text]

Q Do antihypertensive agents prevent onset of microalbuminuria in patients with diabetes without nephropathy and delay progression in patients with diabetic nephropathy?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Nephrology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Endocrine $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$

Key Words: angiotensin converting enzyme inhibitors • antihypertensive agents • calcium channel blockers • diabetic nephropathies • albuminuria

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

METHODS
Data sources: Medline (1966 to September 2003), EMBASE/Excerpta Medica (1988to September 2003), Cochrane Central Register of ControlledTrials (2004), reference lists, and authors in the field.

Study selection and assessment: randomised controlled trials (RCTs) in any language comparingan antihypertensive agent with another antihypertensive agentor placebo in diabetic patients with and without nephropathy.16 RCTs (n = 8570) in diabetic patients without nephropathyand 43 RCTs (n = 7545) in diabetic patients with nephropathymet the selection criteria. Quality assessment of individualstudies was based on allocation concealment, intention to treatanalysis, loss to follow up, and blinding.

Outcomes: onset of microalbuminuria, all cause mortality, end stage renaldisease (ESRD), doubling of serum creatinine, progression frommicroalbuminuria to macroalbuminuria, regression from microalbuminuriato normalbuminuria, cough, headache, hyperkalaemia, and impotence.

MAIN RESULTS
Meta-analysis using a random effects model showed that angiotensinconverting enzyme (ACE) inhibitors were more effective thancalcium antagonists . . . [Full text of this article]

Philip A McFarlane, MD

St Michael’s Hospital,
Toronto, Ontario, Canada