Tags

Type your tag names separated by a space and hit enter

Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis.
Diabet Med. 2007 May; 24(5):486-93.DM

Abstract

AIMS

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta-analysis of studies investigating combination therapy for DN.

METHODS

Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24-h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points.

RESULTS

In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8-12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32-0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 micromol/l 95% CI -0.76-13.73; P = 0.09). Potassium was increased by 0.2 (0.08-0.32) mmol/l (P < 0.01) with ACEI + ARB. Systolic and diastolic blood pressure were reduced by 5.2 (2.1-8.4) mmHg (P < 0.01) and 5.3 (2.2-8.4) mmHg (P < 0.01), respectively.

CONCLUSIONS

This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure. These results should be interpreted cautiously as most of the included studies were of short duration and the few long-term studies (12 months) have not demonstrated benefit.

Authors+Show Affiliations

Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

17367311

Citation

Jennings, D L., et al. "Combination Therapy With an ACE Inhibitor and an Angiotensin Receptor Blocker for Diabetic Nephropathy: a Meta-analysis." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 24, no. 5, 2007, pp. 486-93.
Jennings DL, Kalus JS, Coleman CI, et al. Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis. Diabet Med. 2007;24(5):486-93.
Jennings, D. L., Kalus, J. S., Coleman, C. I., Manierski, C., & Yee, J. (2007). Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis. Diabetic Medicine : a Journal of the British Diabetic Association, 24(5), 486-93.
Jennings DL, et al. Combination Therapy With an ACE Inhibitor and an Angiotensin Receptor Blocker for Diabetic Nephropathy: a Meta-analysis. Diabet Med. 2007;24(5):486-93. PubMed PMID: 17367311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis. AU - Jennings,D L, AU - Kalus,J S, AU - Coleman,C I, AU - Manierski,C, AU - Yee,J, Y1 - 2007/03/15/ PY - 2007/3/21/pubmed PY - 2007/9/27/medline PY - 2007/3/21/entrez SP - 486 EP - 93 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 24 IS - 5 N2 - AIMS: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta-analysis of studies investigating combination therapy for DN. METHODS: Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24-h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points. RESULTS: In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8-12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32-0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 micromol/l 95% CI -0.76-13.73; P = 0.09). Potassium was increased by 0.2 (0.08-0.32) mmol/l (P < 0.01) with ACEI + ARB. Systolic and diastolic blood pressure were reduced by 5.2 (2.1-8.4) mmHg (P < 0.01) and 5.3 (2.2-8.4) mmHg (P < 0.01), respectively. CONCLUSIONS: This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure. These results should be interpreted cautiously as most of the included studies were of short duration and the few long-term studies (12 months) have not demonstrated benefit. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/17367311/Combination_therapy_with_an_ACE_inhibitor_and_an_angiotensin_receptor_blocker_for_diabetic_nephropathy:_a_meta_analysis_ L2 - https://doi.org/10.1111/j.1464-5491.2007.02097.x DB - PRIME DP - Unbound Medicine ER -