Ace Inhibitors Vs Arb
From Anvita Health Wiki
Introduction
- systematic review of 43 trials randomized controlled trials of at least 6 months duration
- combined 43 trials involved 7545 patients with diabetic nephropathy
- 36 trials of ACE inhibitor vs placebo
- 4 trials of ARB vs placebo
- 3 trials of ACE inhibitor vs ARB
- Results:
- mortality reduced significantly with ACE inhibitors ( RR = 0.79), but not with ARBs ( RR = 0.99)
- similar effects of ACE inhibitors & ARBs on end-stage renal disease & doubling of serum creatinine
- small sample size confounded direct comparison of ACE inhibitors with ARB
- randomized, double-blind placebo-controlled trial
- 250 patients with diabetes mellitus type 2 with diabetic nephropathy
- 82% with microalbuminuria
- 18% with proteinuria
- all patients with serum creatinine < 1.6 mg/dL &
- GFR > 70 mL/min/1.73m2
- enalapril (ACE inhibitor) up to 20 mg/day
- telmisartan* (ARB) up to 80 mg/day
- 5 years of follow-up
- Results:
- mean decline in GFR was 18 mL/min/1.73m2 with telmisartan & 15 mL/min/1.73m2 (not a significant difference)
- blood pressure control, changes in serum creatinine, microalbuminuria, end-stage renal disease & cardiovascular events were the same in the 2 groups
- * study supported by manufacturer of telmisartan
References
- Journal Watch 24(23):173, 2004 Strippoli GF, Craig M, Deeks JJ, Schena FP, Craig JC. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ. 2004 Oct 9;329(7470):828. Epub 2004 Sep 30. Review. <PubMed> PMID: [1] <Internet> [2]
- Journal Watch 24(23):174, 2004 Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, Mustonen J; Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med. 2004 Nov 4;351(19):1952-61. Epub 2004 Oct 31. PMID: &dopt=Abstract
- Prescriber's Letter 14(12): 2007 ACE Inhibitors Versus ARBs Detail-Document#: [3] (subscription needed) [4]
- Prescriber's Letter 15(6): 2008 ACE Inhibitors Versus ARBs Detail-Document#: [5] (subscription needed) [6]
