2004/09/30 by Giovanni FM Strippoli, Maria E. Craig, Jonathan J Deeks +2 · 3 citations
Medicine · #Blood Pressure and Hypertension Studies #Chronic Kidney Disease and Diabetes #Renin-Angiotensin System Studies
paper · pdf · doi:10.1136/bmj.38237.585000.7c
openalex publication_date 2004/09/30 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
OBJECTIVE: To evaluate the effects of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (AIIRAs) on renal outcomes and all cause mortality in patients with diabetic nephropathy. DATA SOURCES: Medline, Embase, the Cochrane controlled trials register, conference proceedings, and contact with investigators. STUDY SELECTION: Trials comparing ACE inhibitors or AIIRAs with placebo or with each other in patients with diabetic nephropathy. DATA EXTRACTION: Mortality, renal outcomes (end stage renal disease, doubling of serum creatinine concentration, prevention of progression of microalbuminuria to macroalbuminuria, remission of microalbuminuria), and quality of trials. DATA SYNTHESIS: 36 of 43 identified trials compared ACE inhibitors with placebo (4008 patients), four compared AIIRAs with placebo (3331 patients), and three compared ACE inhibitors with AIIRAs (206 patients). We obtained unpublished data for 11 trials. ACE inhibitors significantly reduced all cause mortality (relative risk 0.79, 95% confidence interval 0.63 to 0.99) compared with placebo but AIIRAs did not (0.99, 0.85 to 1.17), although baseline mortality was similar in the trials. Both agents had similar effects on renal outcomes. Reliable estimates of the unconfounded relative effects of ACE inhibitors compared with AIIRAs could not be obtained owing to small sample sizes. CONCLUSION: Although the survival benefits of ACE inhibitors for patients with diabetic nephropathy are known, the relative effects of ACE inhibitors and AIIRAs on survival are unknown owing to the lack of adequate head to head trials.