Why the study?
Does ARB-based antihypertensive therapy reduce cardiovascular and renal events compared to non-ARB therapy in hypertensive patients with advanced CKD?
RCT (n=1,222)
Open-label
Computer-generated stratified randomization
Yes
Does ARB-based antihypertensive therapy reduce cardiovascular and renal events compared to non-ARB therapy in hypertensive patients with advanced CKD?
In hypertensive patients with advanced CKD, ARB-based therapy significantly reduces cardiovascular and renal events compared to non-ARB therapy, driven by BP-independent renoprotective effects.
Answers are grounded in this paper and cite their sources.
Supports ARB use in hypertensive advanced CKD; extends RCT evidence for CV/renal protection in this population.
The ATTEMPT-CVD study was prospective randomized active-controlled trial and the main findings had been reported. According to baseline GFR and albuminuria categories, we divided the patients of the ATTEMPT-CVD study into 2 subgroups: (Group 1) the patients with at least one of eGFR of <45 ml/min per 1.73 m 2 and UACR of ≥300 mg/g creatinine, defined as G3b and/or A3; (Group 2) the patients except for Group 1, defined as the other patients. In patients with G3b and/or A3, the incidence of cardiovascular events was significantly less in ARB group than in non-ARB group (11 vs 22, respectively) (HR = 0.465: 95%CI = 0.224–0.965; P = 0.040). UACR was significantly less in ARB group than in non-ARB group during follow-up period in patients with G3b and/or A3 (P = 0.0003), while eGFR, plasma BNP levels, and blood pressure were comparable between ARB and non-ARB groups. Allocation to ARB therapy was a significant independent prognostic factor for cardiovascular events in patients with G3b and/or A3 (P = 0.0268). On the other hand, in the other patients, the occurrence of cardiovascular events was comparable between ARB and non-ARB groups. In patients with advanced CKD, ARB-based therapy may confer greater benefit in prevention of cardiovascular events than non-ARB therapy.
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Kim‐Mitsuyama et al. (2018) conducted an RCT in Hypertension with advanced chronic kidney disease (n=1,222). Telmisartan (ARB-based therapy) vs. Non-ARB antihypertensive therapy was evaluated on Composite cardiovascular and renal events in patients with advanced CKD (G3b and/or A3) (HR 0.465, 95% CI 0.224-0.965, p=0.040).
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