Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis
- PMID: 22189484
- PMCID: PMC3268972
- DOI: 10.1007/s00125-011-2398-8
Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis
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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Comment in
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Renoprotective effects of renin-angiotensin-aldosterone system blockers in type 2 diabetes: demystifying multiple treatment comparisons in a network meta-analysis.Diabetologia. 2012 Sep;55(9):2547-8; author reply 2549-50. doi: 10.1007/s00125-012-2619-9. Epub 2012 Jun 23. Diabetologia. 2012. PMID: 22729654 No abstract available.
References
-
- 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
-
- Gall MA. Albuminuria in non-insulin-dependent diabetes mellitus. Prevalence, causes, and consequences. Dan Med Bull. 1997;44:465–485. - PubMed
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