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

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 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 ★★★★★☆☆


Embedded ImageData sources:

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

Embedded ImageStudy 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.

Embedded ImageOutcomes:

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 …

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  • For correspondence: Dr J P Casas, London School of Hygiene and Tropical Medicine, London, UK. juan.pablo-casas{at}

  • Source of funding: no external funding.