Clinical Question: Are angiotensin ...

Clinical Question: Are angiotensin receptor blocker (ARBs) as virtuous as angiotensin-converting enzyme (ACE) inhibitors at preventing the progression of nephropathy?

Setting: Outpatient (any)

subject of attention Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: In this meditation 250 participants with diabetes who had mild to moderate hypertension and evidence of early nephropathy (i.e., urinary albumin excretion rate between 11 and 999 mcg by means of minute and a serum creatinine horizontal of less than 1.6 mg by dL) were randomized to receive telmisartan in a dosage of 40 mg for day or enalapril in a dosage of 10 mg by day. Blood pressure medicines other than an ACE inhibitor or ARB could be added at the discretion of the treating physician to command blood pressure. The primary result was the glomerular filtration rate.

There was a high dropout rate, and the last observation was appropriately carried forward for the analysis. The proceeds for only those patients with concluded data also were reported. In one as well as the other cases, almost no difference in glomerular filtration rate was noted for the first pair years, with a trend toward greater benefit for enalapril that almost became significant at four years and declined slightly at five years.

Bottom Line: Despite a relatively gentle dosage of 10 mg taken one time a day, enalapril was at least as effective as telmisartan and showed a incline toward greater benefit in preventing decline in glomerular filtration rate. Although this studious mood measured a disease-oriented end point, its follows are consistent with the visible form [i]or[/i] frame of literature that supports the les expensive ACE inhibitors as the physic of choice over ARBs. (Level of Evidence: 1b)

reflection Reference: Barnett AH, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in shadow 2 diabetes and nephropathy. N Engl J M November 4 2004;351:1952-61 Used with permission from Ebell M ARB no better than ACEI for prevention of nephropathy progression. Accessed online December 28 2004 at: http://www.InfoPOEMs.com.

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