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- angiotensin converting enzyme inhibitors
- antihypertensive agents
- diabetic nephropathies
- kidney failure (chronic)
- renin-angiotensin system
Q Do angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have renoprotective effects independent of blood pressure (BP) control?
Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★☆☆ Nephrology ★★★★★★☆ Endocrine ★★★★★☆☆
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.
end stage renal disease (ESRD) (need for kidney transplantation or dialysis) and doubling of serum creatinine.
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 …
For correspondence: Dr J P Casas, London School of Hygiene and Tropical Medicine, London, UK.
Source of funding: no external funding.