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Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials.
Nephrol Dial Transplant. 2011 Sep; 26(9):2827-47.ND

Abstract

BACKGROUND

A recent clinical trial showed harmful renal effects with the combined use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) in people with diabetes or vascular disease. We examined the benefits and risks of these agents in people with albuminuria and one or more cardiovascular risk factors.

METHODS

MEDLINE, EMBASE and Renal Health Library were searched for trials comparing ACEI, ARB or their combination with placebo or with one another in people with albuminuria and one or more cardiovascular risk factor.

RESULTS

Eighty-five trials (21,708 patients) were included. There was no significant reduction in the risk of all-cause mortality or fatal cardiac-cerebrovascular outcomes with ACEI versus placebo, ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. There was a significant reduction in the risk of nonfatal cardiovascular events with ACEI versus placebo but not with ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. Development of end-stage kidney disease and progression of microalbuminuria to macroalbuminuria were reduced significantly with ACEI versus placebo and ARB versus placebo but not with combined therapy with ACEI + ARB versus monotherapy.

CONCLUSIONS

ACEI and ARB exert independent renal and nonfatal cardiovascular benefits while their effects on mortality and fatal cardiovascular disease are uncertain. There is a lack of evidence to support the use of combination therapy. A comparative clinical trial with ACE, ARB and its combination in people with albuminuria and a cardiovascular risk factor is warranted.

Authors+Show Affiliations

Department of Pharmacology and Clinical Epidemiology, Mario Negri Sud Consortium, S. Maria Imbaro (Ch), Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

21372254

Citation

Maione, Ausilia, et al. "Angiotensin-converting Enzyme Inhibitors, Angiotensin Receptor Blockers and Combined Therapy in Patients With Micro- and Macroalbuminuria and Other Cardiovascular Risk Factors: a Systematic Review of Randomized Controlled Trials." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 26, no. 9, 2011, pp. 2827-47.
Maione A, Navaneethan SD, Graziano G, et al. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials. Nephrol Dial Transplant. 2011;26(9):2827-47.
Maione, A., Navaneethan, S. D., Graziano, G., Mitchell, R., Johnson, D., Mann, J. F., Gao, P., Craig, J. C., Tognoni, G., Perkovic, V., Nicolucci, A., De Cosmo, S., Sasso, A., Lamacchia, O., Cignarelli, M., Manfreda, V. M., Gentile, G., & Strippoli, G. F. (2011). Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 26(9), 2827-47. https://doi.org/10.1093/ndt/gfq792
Maione A, et al. Angiotensin-converting Enzyme Inhibitors, Angiotensin Receptor Blockers and Combined Therapy in Patients With Micro- and Macroalbuminuria and Other Cardiovascular Risk Factors: a Systematic Review of Randomized Controlled Trials. Nephrol Dial Transplant. 2011;26(9):2827-47. PubMed PMID: 21372254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials. AU - Maione,Ausilia, AU - Navaneethan,Sankar D, AU - Graziano,Giusi, AU - Mitchell,Ruth, AU - Johnson,David, AU - Mann,Johannes F E, AU - Gao,Peggy, AU - Craig,Jonathan C, AU - Tognoni,Giovanni, AU - Perkovic,Vlado, AU - Nicolucci,Antonio, AU - De Cosmo,Salvatore, AU - Sasso,Antonio, AU - Lamacchia,Olga, AU - Cignarelli,Mauro, AU - Manfreda,Valeria Maria, AU - Gentile,Giorgio, AU - Strippoli,Giovanni F M, Y1 - 2011/03/03/ PY - 2011/3/5/entrez PY - 2011/3/5/pubmed PY - 2012/1/20/medline SP - 2827 EP - 47 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 26 IS - 9 N2 - BACKGROUND: A recent clinical trial showed harmful renal effects with the combined use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) in people with diabetes or vascular disease. We examined the benefits and risks of these agents in people with albuminuria and one or more cardiovascular risk factors. METHODS: MEDLINE, EMBASE and Renal Health Library were searched for trials comparing ACEI, ARB or their combination with placebo or with one another in people with albuminuria and one or more cardiovascular risk factor. RESULTS: Eighty-five trials (21,708 patients) were included. There was no significant reduction in the risk of all-cause mortality or fatal cardiac-cerebrovascular outcomes with ACEI versus placebo, ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. There was a significant reduction in the risk of nonfatal cardiovascular events with ACEI versus placebo but not with ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. Development of end-stage kidney disease and progression of microalbuminuria to macroalbuminuria were reduced significantly with ACEI versus placebo and ARB versus placebo but not with combined therapy with ACEI + ARB versus monotherapy. CONCLUSIONS: ACEI and ARB exert independent renal and nonfatal cardiovascular benefits while their effects on mortality and fatal cardiovascular disease are uncertain. There is a lack of evidence to support the use of combination therapy. A comparative clinical trial with ACE, ARB and its combination in people with albuminuria and a cardiovascular risk factor is warranted. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/21372254/Angiotensin_converting_enzyme_inhibitors_angiotensin_receptor_blockers_and_combined_therapy_in_patients_with_micro__and_macroalbuminuria_and_other_cardiovascular_risk_factors:_a_systematic_review_of_randomized_controlled_trials_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfq792 DB - PRIME DP - Unbound Medicine ER -