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

• Published in: Diabetic medicine 2007-05, Vol.24 (5), p.486-493
• Main Authors: Jennings, D. L., Kalus, J. S., Coleman, C. I., Manierski, C., Yee, J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin Receptor Antagonists; angiotensin-converting enzyme inhibitor; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; angiotensin-receptor blocker; Biological and medical sciences; combination therapy; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - complications; Diabetic Nephropathies - drug therapy; diabetic nephropathy; Drug Therapy, Combination; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Kidney Diseases - etiology; Kidney Diseases - prevention & control; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Receptors, Angiotensin - therapeutic use; Urinary system involvement in other diseases. Miscellaneous
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2007.02097.x

Aims  Angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin–angiotensin–aldosterone system (RAAS)‐inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta‐analysis of studies investigating combination therapy for DN. Methods  Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24‐h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points. Results  In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8–12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32–0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 µmol/l 95% CI −0.76–13.73; P = 0.09). Potassium was increased by 0.2 (0.08–0.32) mmol/l (P