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

Ausilia Maione, Sankar D. Navaneethan, Giusi Graziano, Ruth Mitchell, David Johnson, Johannes F E Mann, Peggy Gao, Jonathan C. Craig, Giovanni Tognoni, Vlado Perkovic, Antonio Nicolucci, Salvatore De Cosmo, Antonio Sasso, Olga Lamacchia, Mauro Cignarelli, Valeria Maria Manfreda, Giorgio Gentile, Giovanni F M Strippoli

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)2827-2847
Number of pages21
JournalNephrology Dialysis Transplantation
Volume26
Issue number9
DOIs
Publication statusPublished - Sep 2011

Keywords

  • angiotensin receptor blockers
  • angiotensin-converting enzyme inhibitors
  • macroalbuminuria
  • microalbuminuria

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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