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Review: the renoprotective effects of ACE inhibitors and ARBs independent of blood pressure control are uncertain

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

Key Words: angiotensin converting enzyme inhibitors • antihypertensive agents • diabetic nephropathies • kidney failure (chronic) • renin-angiotensin system

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

METHODS
Data sources: Medline, EMBASE/Excerpta Medica, and the Cochrane Library (1960 to January 2005); and references of relevant studies and reviews.

Study selection and assessment: randomised controlled trials (RCTs) with 1 year follow up that examined the effect of drug treatment with a BP lowering action on progression of renal disease. 127 RCTs (150 comparisons) with mean follow up of 4.2 years met the selection criteria.

Outcomes: end stage renal disease (ESRD) (need for kidney transplantation or dialysis) and doubling of serum creatinine.

MAIN RESULTS
Changes in BP were similar across the 5 outcomes; all but 1 showed no difference in the degree of change in systolic and diastolic BP between patients receiving ACE inhibitors or ARBs and those receiving other antihypertensive drugs; ACE inhibitor or ARB treatment led to a reduction in systolic BP of 1.49 mm Hg (95% CI 0.05 to 2.92) in studies with change in creatinine concentration as an . . . [Full text of this article]

Catherine Clase, MB, BChir¹, Amit X Garg, MD, PhD²

¹ McMaster University, Hamilton, Ontario, Canada
² University of Western Ontario, London, Ontario, Canada