Why the study?
Evidence has been inconsistent regarding the short- and long-term therapeutic effects of ACE inhibitors versus CCBs for preventing the progression of early diabetic nephropathy.
Do ACE inhibitors compared to CCBs reduce albuminuria progression in patients with early diabetic nephropathy?
Do ACE inhibitors compared to CCBs reduce albuminuria progression in patients with early diabetic nephropathy?
ACE inhibitors provide greater short-term reduction in albuminuria compared to CCBs in early diabetic nephropathy, but both are equally effective in preventing long-term progression to macroalbuminuria.
Answers are grounded in this paper and cite their sources.
ACE inhibitors may be preferred short-term for albuminuria reduction in early diabetic nephropathy; extends evidence of equivalent long-term progression prevention versus CCBs.
Treatments with angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers (CCBs) may delay the development of albuminuria in patients with early diabetic nephropathy. However, evidence in the literature has not been consistent. The present meta-analysis aimed to compare the short- and long-term therapeutic effects of ACE inhibitors and CCBs (when used separately) for preventing the progression of nephropathy in patients with diabetes mellitus. A comprehensive search of various databases was performed from inception until March 2015 for studies in the Chinese and English languages. Randomized controlled trials (RCTs) comparing the efficacy of ACE inhibitors with that of CCBs in patients with early diabetic nephropathy were considered. A total of 12 RCTs were included with a total of 947 patients. ACE inhibitors were indicated to be more effective in reducing the albumin excretion rate than CCBs after short-term treatments (<6 months) [mean difference (MD), 32.35; 95% confidence interval (CI), 31.62-33.07; P<0.00001]. There was no difference in serum creatinine values after treatment with either drug (MD, 8.7; 95% CI, -21.5-38.91; P=0.57). Data from six studies were used to compare long-term treatment effects (≥1 year). In terms of progression to normoalbuminuria, a marginal difference was obtained between the two drugs with better outcomes with ACE inhibitors [odds ratio (OR), 0.70; 95% CI, 0.49-1.00; P=0.05]. There was no statistically significant difference between ACE inhibitors and CCBs regarding the progression from microalbuminuria to macroalbuminuria (OR, 1.78; 95% CI, 0.82-3.87; P=0.15). In conclusion, the present study indicated that the antiproteinuric efficacy of CCBs may be less than that of ACE inhibitors after short-term treatment in patients with DN. However, both types of drugs are equally effective in reducing the progression of microalbuminuria to macroalbuminuria in the long term.
No takes yet. Share an insight, caveat, or question.
Liang et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: