Key result
ACE inhibitors and ARBs significantly decreased albuminuria by a mean difference of 80.28 mg/d compared to placebo or active controls in normotensive patients with diabetic kidney disease.
Why the study?
The efficacy and safety of ACE inhibitors and angiotensin receptor blockers in normotensive patients with diabetic kidney disease remain controversial.
Does ACEI or ARB therapy reduce albuminuria and cardiovascular events in normotensive patients with diabetic kidney disease?
Meta-Analysis (n=1,282)
Does ACEI or ARB therapy reduce albuminuria and cardiovascular events in normotensive patients with diabetic kidney disease?
Mean Difference: -80.28 (95% CI -104.79–-55.77)
p-value: p=<0.001
ACE inhibitors and ARBs significantly reduce albuminuria in normotensive patients with diabetic kidney disease, particularly those with type 2 diabetes, without increasing adverse events, though they do not significantly impact eGFR decline or cardiovascular events.
Supports ACEI (not ARB) use to slow albuminuria in normotensive DKD; extends evidence from hypertensive trials but needs larger RCTs.
The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing the progression of albuminuria and risk of cardiovascular events in hypertensive patients with diabetic kidney disease (DKD) is well-documented. However, the efficacy and safety of these agents in normotensive patients with DKD are still controversial. MEDLINE, Embase, and Cochrane Library were searched for relevant random controlled trials. The odd risk (OR) reductions were calculated with a random-effects model. Decrease in albuminuria, changes in eGFR, major cardiovascular events, and drug-related adverse events were analyzed. Thirteen RCTs including 1282 patients were retrieved. Compared with placebo or other active agent groups, ACEIs or ARBs significantly decreased albuminuria (MD –80.28 mg/d, 95% CI –104.79 mg/d to –55.77 mg/d), and the efficacy is independent of changes in blood pressure and systolic blood pressure at baseline. The result of subanalysis showed the declining of albuminuria was more significantly in normotensive DKD patients with 2DM (p=0.005). No significant differences were found with regard to the declining of evaluated glomerular filtration rate (eGFR) (MD –0.29 ml/min/1.73 m2, 95% CI –2.99 to 2.41 ml/min/1.73 m2). There were no significant differences in the side effect of the drugs such as hypotension and hyperkalemia. This meta-analysis demonstrated that ACEIs or ARBs can decrease albuminuria to varying degree in normotensive patients with DKD, and better response occurred in patients with 2DM.
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He et al. (2020) conducted a meta-analysis in Normotensive diabetic kidney disease (n=1,282). ACE inhibitors or Angiotensin Receptor Blockers (ARBs) vs. Placebo or other antihypertensive agents was evaluated on Decrease in albuminuria (MD -80.28 mg/d, 95% CI -104.79 to -55.77, p=<0.001). ACE inhibitors and ARBs significantly decreased albuminuria by a mean difference of 80.28 mg/d compared to placebo or active controls in normotensive patients with diabetic kidney disease.
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