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Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis.
Diabetologia 2012; 55(3):566-78D

Abstract

AIMS/HYPOTHESIS

This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and other antihypertensive drugs or placebo in type 2 diabetes.

METHODS

Publications were identified from Medline and Embase up to July 2011. Only randomised controlled trials comparing ACEI/ARB monotherapy with other active drugs or placebo were eligible. The outcome of end-stage renal disease, doubling of serum creatinine, microvascular complications, microalbuminuria, macroalbuminuria and albuminuria regression were extracted. Risk ratios were pooled using a random-effects model if heterogeneity was present; a fixed-effects model was used in the absence of heterogeneity.

RESULTS

Of 673 studies identified, 28 were eligible (n = 13-4,912). In direct meta-analysis, ACEI/ARB had significantly lower risk of serum creatinine doubling (pooled RR = 0.66 [95% CI 0.52, 0.83]), macroalbuminuria (pooled RR = 0.70 [95% CI 0.50, 1.00]) and albuminuria regression (pooled RR 1.16 [95% CI 1.00, 1.39]) than other antihypertensive drugs, mainly calcium channel blockers (CCBs). Although the risks of end-stage renal disease and microalbuminuria were lower in the ACEI/ARB group (pooled RR 0.82 [95% CI 0.64, 1.05] and 0.84 [95% CI 0.61, 1.15], respectively), the differences were not statistically significant. The ACEI/ARB benefit over placebo was significant for all outcomes except microalbuminuria. A network meta-analysis detected significant treatment effects across all outcomes for both active drugs and placebo comparisons.

CONCLUSIONS/INTERPRETATION

Our review suggests a consistent reno-protective effect of ACEI/ARB over other antihypertensive drugs, mainly CCBs, and placebo in type 2 diabetes. The lack of any differences in BP decrease between ACEI/ARB and active comparators suggest this benefit is not due simply to the antihypertensive effect.

Authors+Show Affiliations

Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Rachatevi, Bangkok 10400, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22189484

Citation

Vejakama, P, et al. "Reno-protective Effects of Renin-angiotensin System Blockade in Type 2 Diabetic Patients: a Systematic Review and Network Meta-analysis." Diabetologia, vol. 55, no. 3, 2012, pp. 566-78.
Vejakama P, Thakkinstian A, Lertrattananon D, et al. Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. Diabetologia. 2012;55(3):566-78.
Vejakama, P., Thakkinstian, A., Lertrattananon, D., Ingsathit, A., Ngarmukos, C., & Attia, J. (2012). Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. Diabetologia, 55(3), pp. 566-78. doi:10.1007/s00125-011-2398-8.
Vejakama P, et al. Reno-protective Effects of Renin-angiotensin System Blockade in Type 2 Diabetic Patients: a Systematic Review and Network Meta-analysis. Diabetologia. 2012;55(3):566-78. PubMed PMID: 22189484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. AU - Vejakama,P, AU - Thakkinstian,A, AU - Lertrattananon,D, AU - Ingsathit,A, AU - Ngarmukos,C, AU - Attia,J, Y1 - 2011/12/22/ PY - 2011/09/09/received PY - 2011/11/07/accepted PY - 2011/12/23/entrez PY - 2011/12/23/pubmed PY - 2012/7/20/medline SP - 566 EP - 78 JF - Diabetologia JO - Diabetologia VL - 55 IS - 3 N2 - AIMS/HYPOTHESIS: This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and other antihypertensive drugs or placebo in type 2 diabetes. METHODS: Publications were identified from Medline and Embase up to July 2011. Only randomised controlled trials comparing ACEI/ARB monotherapy with other active drugs or placebo were eligible. The outcome of end-stage renal disease, doubling of serum creatinine, microvascular complications, microalbuminuria, macroalbuminuria and albuminuria regression were extracted. Risk ratios were pooled using a random-effects model if heterogeneity was present; a fixed-effects model was used in the absence of heterogeneity. RESULTS: Of 673 studies identified, 28 were eligible (n = 13-4,912). In direct meta-analysis, ACEI/ARB had significantly lower risk of serum creatinine doubling (pooled RR = 0.66 [95% CI 0.52, 0.83]), macroalbuminuria (pooled RR = 0.70 [95% CI 0.50, 1.00]) and albuminuria regression (pooled RR 1.16 [95% CI 1.00, 1.39]) than other antihypertensive drugs, mainly calcium channel blockers (CCBs). Although the risks of end-stage renal disease and microalbuminuria were lower in the ACEI/ARB group (pooled RR 0.82 [95% CI 0.64, 1.05] and 0.84 [95% CI 0.61, 1.15], respectively), the differences were not statistically significant. The ACEI/ARB benefit over placebo was significant for all outcomes except microalbuminuria. A network meta-analysis detected significant treatment effects across all outcomes for both active drugs and placebo comparisons. CONCLUSIONS/INTERPRETATION: Our review suggests a consistent reno-protective effect of ACEI/ARB over other antihypertensive drugs, mainly CCBs, and placebo in type 2 diabetes. The lack of any differences in BP decrease between ACEI/ARB and active comparators suggest this benefit is not due simply to the antihypertensive effect. SN - 1432-0428 UR - https://www.unboundmedicine.com/medline/citation/22189484/Reno_protective_effects_of_renin_angiotensin_system_blockade_in_type_2_diabetic_patients:_a_systematic_review_and_network_meta_analysis_ L2 - https://dx.doi.org/10.1007/s00125-011-2398-8 DB - PRIME DP - Unbound Medicine ER -