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March 15, 2007Diabetic MedicineOpen Access

Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta‐analysis

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Why the study?

Does combination therapy with an ACE inhibitor and an ARB reduce 24-h urinary protein excretion in patients with diabetic nephropathy compared to ACE inhibitor alone?

Population

10 trials pooling 315 patients with diabetic nephropathy

Comparison

Combination therapy with an ACE inhibitor and an… vs ACE inhibitor (ACEI) alone

Design

Meta-analysis

Follow-up

8-12 weeks (most studies)

Authors

DJDouglas L. JenningsJKJames S. KalusCCCraig I Coleman

Discussion

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Overview

Warrants caution with dual blockade despite proteinuria benefit; heterogeneity and adverse GFR/potassium effects leave long-term role open.

Structured PICO

Does combination therapy with an ACE inhibitor and an ARB reduce 24-h urinary protein excretion in patients with diabetic nephropathy compared to ACE inhibitor alone?

P
Population
10 trials pooling 315 patients with diabetic nephropathy
I
Intervention
Combination therapy with an ACE inhibitor (ACEI) and an angiotensin receptor blocker (ARB)
C
Comparator
ACE inhibitor (ACEI) alone
O
Outcome
24-h urinary protein excretionsurrogate

Combination ACEI and ARB therapy reduces proteinuria more than ACEI alone in diabetic nephropathy but is associated with adverse effects on GFR and potassium, with uncertain long-term benefits.

Limitations

  • Most included studies were of short duration
  • Few long-term studies (12 months) have not demonstrated benefit

Cite This Study

Jennings et al. (2007) studied this question.

synapsesocial.com/papers/6a6fa693f44fa9f079dd1d8dhttps://doi.org/10.1111/j.1464-5491.2007.02097.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Combination of half doses of angiotensin type 1 receptor antagonist and angiotensin-converting enzyme inhibitor in diabetic nephropathy2005 · 35 citations
  2. 2Dual Blockade of the Renin-Angiotensin System in Diabetic Nephropathy2002 · 205 citations
  3. 3Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study2000 · 1,040 citations
  4. 4Effective Postponement of Diabetic Nephropathy With Enalapril in Normotensive Type 2 Diabetic Patients With Microalbuminuria1997 · 202 citations
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