- Title
- Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis
- Creator
- Vejakama, P.; Thakkinstian, A.; Lertrattananon, D.; Ingsathit, A.; Ngarmukos, C.; Attia, J.
- Relation
- Diabetologia Vol. 55, Issue 3, p. 566-578
- Publisher Link
- http://dx.doi.org/10.1007/s00125-011-2398-8
- Publisher
- Springer
- Resource Type
- journal article
- Date
- 2012
- Description
- 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/Interpretations: 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.
- Subject
- albuminuria regression; angiotensin receptor blockers; systematic review; type 2 diabetes; angiotensin-converting enzyme inhibitors; doubling of serum creatinine; end-stage renal disease; macroalbuminuria; meta-analysis; microalbuminuria; renin–angiotensin system blockade; reno-protective effect
- Identifier
- http://hdl.handle.net/1959.13/1301915
- Identifier
- uon:20369
- Identifier
- ISSN:0012-186X
- Language
- eng
- Full Text
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