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Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis.
Am Heart J. 2008 May; 155(5):791-805.AH

Abstract

OBJECTIVE

The role of renin angiotensin system (RAS) blockade in controlling hypertension and the positive impact on cardiovascular (CV) outcomes is well known. However, the role of RAS blockade in improving CV outcomes in patients with chronic kidney disease (CKD) is still unclear.

METHODS

Randomized controlled trials that analyzed CV outcomes in patients with CKD/proteinuria treated with RAS blockade (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) were included in our study. The relative risk across all study groups was computed using Mantel-Hanszel random effects model. Results were calculated with 95% CI and was considered statistically significant if 2-sided alpha error was <.05. Renin angiotensin system blockade-based therapy was compared with placebo and control (beta-blocker, calcium-channel blockers and other antihypertensive-based therapy) therapy in the study.

RESULTS

Twenty-five trials (N = 45758) were used for analysis. Renin angiotensin system blockade decreased the risk for heart failure in patients with diabetic nephropathy when compared with placebo 0.78 (95% CI 0.66-0.92, P = .003) and control therapy (0.63, 95% CI 0.47-0.86, P = .003). The risk for CV outcomes was decreased with RAS blockade (0.56, 95% CI 0.47-0.67, P < .001) in nondiabetic nephropathy patients with CKD when compared with control therapy. There was also a significant reduction of CV outcomes (0.84, 95% CI 0.78-0.91, P < .0001), myocardial infarction (0.78, 95% CI 0.65-0.97, P = .03), and heart failure (0.74, 95% CI 0.58-0.95, P = .02) when we pooled all the patients with CKD and compared RAS blockade to placebo.

CONCLUSIONS

A pooled analysis of all causes of CKD revealed a reduction in the risk for myocardial infarction, heart failure, and total CV outcomes when RAS blockade was compared with placebo. RAS blockade decreases the risk for CV outcomes and heart failure when compared with control therapy in patients with proteinuria. There were also benefits with RAS blockade in reducing the risk of CV outcomes and heart failure in patients with diabetic nephropathy when compared with placebo.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Rosalind Franklin University/Chicago Medical School, Chicago, IL 60064, USA. balsarav@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

18440325

Citation

Balamuthusamy, Saravanan, et al. "Renin Angiotensin System Blockade and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Proteinuria: a Meta-analysis." American Heart Journal, vol. 155, no. 5, 2008, pp. 791-805.
Balamuthusamy S, Srinivasan L, Verma M, et al. Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. Am Heart J. 2008;155(5):791-805.
Balamuthusamy, S., Srinivasan, L., Verma, M., Adigopula, S., Jalandhara, N., Jalandara, N., Hathiwala, S., & Smith, E. (2008). Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. American Heart Journal, 155(5), 791-805. https://doi.org/10.1016/j.ahj.2008.01.031
Balamuthusamy S, et al. Renin Angiotensin System Blockade and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Proteinuria: a Meta-analysis. Am Heart J. 2008;155(5):791-805. PubMed PMID: 18440325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. AU - Balamuthusamy,Saravanan, AU - Srinivasan,Lavanya, AU - Verma,Meenakshi, AU - Adigopula,Sasikanth, AU - Jalandhara,Nishant, AU - Jalandara,Nishant, AU - Hathiwala,Suresh, AU - Smith,Earl, PY - 2007/09/03/received PY - 2008/01/24/accepted PY - 2008/4/29/pubmed PY - 2008/5/28/medline PY - 2008/4/29/entrez SP - 791 EP - 805 JF - American heart journal JO - Am Heart J VL - 155 IS - 5 N2 - OBJECTIVE: The role of renin angiotensin system (RAS) blockade in controlling hypertension and the positive impact on cardiovascular (CV) outcomes is well known. However, the role of RAS blockade in improving CV outcomes in patients with chronic kidney disease (CKD) is still unclear. METHODS: Randomized controlled trials that analyzed CV outcomes in patients with CKD/proteinuria treated with RAS blockade (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) were included in our study. The relative risk across all study groups was computed using Mantel-Hanszel random effects model. Results were calculated with 95% CI and was considered statistically significant if 2-sided alpha error was <.05. Renin angiotensin system blockade-based therapy was compared with placebo and control (beta-blocker, calcium-channel blockers and other antihypertensive-based therapy) therapy in the study. RESULTS: Twenty-five trials (N = 45758) were used for analysis. Renin angiotensin system blockade decreased the risk for heart failure in patients with diabetic nephropathy when compared with placebo 0.78 (95% CI 0.66-0.92, P = .003) and control therapy (0.63, 95% CI 0.47-0.86, P = .003). The risk for CV outcomes was decreased with RAS blockade (0.56, 95% CI 0.47-0.67, P < .001) in nondiabetic nephropathy patients with CKD when compared with control therapy. There was also a significant reduction of CV outcomes (0.84, 95% CI 0.78-0.91, P < .0001), myocardial infarction (0.78, 95% CI 0.65-0.97, P = .03), and heart failure (0.74, 95% CI 0.58-0.95, P = .02) when we pooled all the patients with CKD and compared RAS blockade to placebo. CONCLUSIONS: A pooled analysis of all causes of CKD revealed a reduction in the risk for myocardial infarction, heart failure, and total CV outcomes when RAS blockade was compared with placebo. RAS blockade decreases the risk for CV outcomes and heart failure when compared with control therapy in patients with proteinuria. There were also benefits with RAS blockade in reducing the risk of CV outcomes and heart failure in patients with diabetic nephropathy when compared with placebo. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18440325/Renin_angiotensin_system_blockade_and_cardiovascular_outcomes_in_patients_with_chronic_kidney_disease_and_proteinuria:_a_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00136-1 DB - PRIME DP - Unbound Medicine ER -