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Comparative Study
. 2012 Mar;55(3):566-78.
doi: 10.1007/s00125-011-2398-8. Epub 2011 Dec 22.

Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis

Affiliations
Comparative Study

Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis

P Vejakama et al. Diabetologia. 2012 Mar.

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.

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Figures

Fig. 1
Fig. 1
Flow of study selection
Fig. 2
Fig. 2
Forest plots of treatment effects between ACEIs and other active drugs: (a) ESRD; (b) doubling of serum creatinine; (c) major microvascular complications; (d) macroalbuminuria; (e) microalbuminuria; and (f) albuminuria regression
Fig. 2
Fig. 2
Forest plots of treatment effects between ACEIs and other active drugs: (a) ESRD; (b) doubling of serum creatinine; (c) major microvascular complications; (d) macroalbuminuria; (e) microalbuminuria; and (f) albuminuria regression

Comment in

References

    1. Scheffel RS, Bortolanza D, Weber CS, et al. Prevalence of micro and macroangiopatic chronic complications and their risk factors in the care of outpatients with type 2 diabetes mellitus. Rev Assoc Med Bras. 2004;50:263–267. doi: 10.1590/S0104-42302004000300031. - DOI - PubMed
    1. Ubink-Veltmaat LJ, Bilo HJ, Meyboom-de Jong B. Microalbuminuria in patients with type 2 diabetes mellitus in general practice. Ned Tijdschr Geneeskd. 2004;148:2026–2030. - PubMed
    1. Wu AY, Kong NC, de Leon FA, et al. An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia. 2005;48:17–26. doi: 10.1007/s00125-004-1599-9. - DOI - PubMed
    1. Gall MA. Albuminuria in non-insulin-dependent diabetes mellitus. Prevalence, causes, and consequences. Dan Med Bull. 1997;44:465–485. - PubMed
    1. Garg JP, Bakris GL. Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vasc Med. 2002;7:35–43. doi: 10.1191/1358863x02vm412ra. - DOI - PubMed

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