Abstract | BACKGROUND: PURPOSE: To establish the effect of ARBs versus placebo and alternative treatments, and the effect of combined treatment with ARBs and ACE inhibitors, on proteinuria. DATA SOURCES: English-language studies in MEDLINE and the Cochrane Library Central Register of Controlled Trials (January 1990 to September 2006), reference lists, and expert contacts. STUDY SELECTION: DATA EXTRACTION: Two investigators independently searched and abstracted studies. DATA SYNTHESIS: Forty-nine studies involving 6181 participants reported results of 72 comparisons with 1 to 4 months of follow-up and 38 comparisons with 5 to 12 months of follow-up. The ARBs reduced proteinuria compared with placebo or calcium-channel blockers over 1 to 4 months (ratio of means, 0.57 [95% CI, 0.47 to 0.68] and 0.69 [CI, 0.62 to 0.77], respectively) and 5 to 12 months (ratio of means, 0.66 [CI, 0.63 to 0.69] and 0.62 [CI, 0.55 to 0.70], respectively). The ARBs and ACE inhibitors reduced proteinuria to a similar degree. The combination of ARBs and ACE inhibitors further reduced proteinuria more than either agent alone: The ratio of means for combination therapy versus ARBs was 0.76 (CI, 0.68 to 0.85) over 1 to 4 months and 0.75 (CI, 0.61 to 0.92) over 5 to 12 months; for combination therapy versus ACE inhibitors, the ratio of means was 0.78 (CI, 0.72 to 0.84) over 1 to 4 months and 0.82 (CI, 0.67 to 1.01) over 5 to 12 months. The antiproteinuric effect was consistent across subgroups. LIMITATIONS: CONCLUSION: The ARBs reduce proteinuria, independent of the degree of proteinuria and of underlying disease. The magnitude of effect is similar regardless of whether the comparator is placebo or calcium-channel blocker. Reduction in proteinuria from ARBs and ACE inhibitors is similar, but their combination is more effective than either drug alone. Uncertainty concerning adverse effects and outcomes that are important to patients limits applicability of findings to clinical practice.
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Authors | Regina Kunz, Chris Friedrich, Marcel Wolbers, Johannes F E Mann |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 148
Issue 1
Pg. 30-48
(Jan 01 2008)
ISSN: 1539-3704 [Electronic] United States |
PMID | 17984482
(Publication Type: Journal Article, Meta-Analysis)
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Chemical References |
- Angiotensin II Type 1 Receptor Blockers
- Angiotensin-Converting Enzyme Inhibitors
- Calcium Channel Blockers
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Topics |
- Angiotensin II Type 1 Receptor Blockers
(adverse effects, therapeutic use)
- Angiotensin-Converting Enzyme Inhibitors
(adverse effects, therapeutic use)
- Calcium Channel Blockers
(adverse effects, therapeutic use)
- Drug Therapy, Combination
- Humans
- Kidney Diseases
(complications, urine)
- Proteinuria
(drug therapy)
- Randomized Controlled Trials as Topic
- Renin-Angiotensin System
(drug effects)
- Sensitivity and Specificity
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