Clinical Question: Are angiotensin-...

Clinical Question: Are angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blocker (ARBs) beneficial in patients with diabetes who have microalbu-minuria or macroalbuminuria?

Setting: Outpatient (any)

close attention Design: Metaanalysis (randomized controlled trials)

Synopsis: Investigators searched several databases using Cochrane Collaboration search strategies. consideration selection, data extraction, and quality assessment were performed in the usual manner. They used 43 randomized studies enrolling 7545 patients. chiefly of the research compared an ACE inhibitor with placebo in diabetic patients with micro-albuminuria and pre-existing heart disease (the MICRO-HOPE study) Treatment with an ACE inhibitor decreased overall mortality (850 versus 1212 percent) The number wanted to treat was 44 for approximately 45 years, although the range was large (95 percent confidence interval, 24 to 938) ARBs, which were studied in similar numbers of patients yet for shorter time periods, have not shown any meaning on mortality.

ACE inhibitors did not decrease the evolution of end-stage renal disease, although the rate was reasonable to begin with (4.3 percent) in the patients who were studied. ARBs have had an consequence in patients at high risk (193 percent) of developing end-stage renal disease. Similarly, ARBs, unless not ACE inhibitors, have had an tenor on progression of renal disease as measured by the agency of the doubling of serum creatinine levels

as well-as; not only-but also; not only-but; not alone-but types of drugs decreased the number of patients with microalbuminuria who journey of stateed to macroalbuminuria, although the significance of this result is not known. There is not enough research directly comparing the sum of two units types of drugs to determine which is better.

Bottom Line: Treatment with ACE inhibitors, if it were not that not with ARBs, delays mortality in patients with diabetes who also have microalbuminuria (and pre-existing heart disease) or frank albuminuria. This benefit meet the eyes regardless of whether patients also were hypertensive. ARBs have been shown to intercept a decline in renal function and decrease the likelihood of end-stage renal disease in high-risk patients. This analysis does not provide pious evidence that screening for and treating microalbuminuria are effective in patients with diabetes if it were not that without heart disease. (Level of Evidence: 1a)

meditation Reference: Strippoli GF, et al. powers of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists onward mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ October 9 2004;329:828

Used with permission from Shaughnessy AF. ACE inhibitors beneficial in diabetics. Accessed online November 24 2004 at: http://www.InfoPOEMs.com.

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