(Strength of Recommendation [SOR]: C, based on a meta-analysis of randomized controlled trials [RCTs] with disease-oriented outcomes.) This site needs JavaScript to work properly.
KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Should all patients with type 1 diabetes mellitus and microalbuminuria receive angiotensin-converting enzyme inhibitors?
COVID-19 is an emerging, rapidly evolving situation. Should angiotensin-converting enzyme inhibitors (ACE-I) be used for diabetic patients with hypertension only if there is also proteinuria? Bashir K. Strategies that interrupt the renin-angiotensin system, especially with angiotensin-converting enzyme (ACE) inhibition, reduce cardiovascular disease mortality and morbidity in high-risk persons such as those with the insulin resistance syndrome and diabetes mellitus. Long-term effect of ACE inhibition on development of nephropathy in diabetes mellitus type II. In diabetic patients with nephropathy, ACE inhibitors reduced all cause mortality more than placebo, but angiotensin receptor blockers (ARBs) did not (table). AL���s����|q�����( Springer Reduction of microalbuminuria by using losartan in normotensive patients with type 2 diabetes mellitus: a randomized controlled trial. The HOPE study demonstrated that ACE inhibitor therapy significantly reduces cardiovascular events in type 2 diabetes independent of hypertension status.Evidence-based answers from the Family Physicians Inquiries Network
Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. A 2-year randomized controlled trial compared lisinopril (Prinivil; Zestril) 10 mg/d with placebo in 530 normotensive adults (aged 20–59 years) with insulin-dependent diabetes, defined as those diagnosed with diabetes before age 36 and using continuous insulin therapy within 1 year of diagnosis. Lang R, Ravid M, et al.
Recommendations are not available for normotensive patients without diabetes who have microalbuminuria.A 2001 meta-analysis of 10 small RCTs (N = 698) described the effect of ACE inhibitors vs. placebo on progression to macro-albuminuria in normotensive patients with microalbuminuria and type 1 diabetes.All studies demonstrated the benefits of therapy with ACE inhibitors and ARBs on urinary albumin excretion in patients with type 2 diabetes, but the magnitude of effect varied by comparison group.
Definition; Causes; Prevalence; Complications; Prognosis ; Chronic kidney disease: Summary. Blood pressure control to goal is advantageous regardless of agent used. The benefits were similar in patients with and without hypertension. ACE-inhibitors and AIIRAs; Background information. ACE inhibitors reduce the risk of progression to macroalbuminuria in normotensive patients with microalbuminuria and type 1 diabetes mellitus. During the past several years controlled clinical trials have demonstrated that ACE inhibition reduces cardiovascular disease (CVD) mortality and morbidity.
Savin H, The AER of the treatment group dropped from 11.6 mg/24 hr initially to 9.7 mg/24 hr at 2 years, then rose to 15.8 mg/24 hr at 6 years. In the Ramipril Efficacy in Nephropathy (REIN) study, ramipril therapy prevented the need for dialysis when used for 3 to 4 yrs in patients with proteinuria and CKD (19,20).These and other results were consistent with a renoprotective effect exceeding that attributable to BP lowering alone (13,20). Subsequent trials have demonstrated a similar benefit in patients with type 2 diabetes and with the use of angiotensin II receptor blockers (ARBs). The goal of treating high blood pressure (HBP or hypertension) traditionally has been to reduce the blood pressure to a certain level (e.g., to less than 140/90).
Our usual practice is to begin an ACE inhibitor or ARB in people with diabetes found to be hypertensive, proteinuric or both, to prevent progression of diabetic kidney disease. EVIDENCE-BASED ANSWER. Angiotensin-converting enzyme (ACE) inhibitors were initially shown to slow the progression of established renal disease in patients with type 1 diabetes. This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.A collection of FPIN's Clinical Inquiries published in Copyright © 2020 American Academy of Family Physicians. There is no evidence that any specific ACEI offers any advantage over the class effect. To see the full article, log in or purchase access.ARR = absolute risk reduction; CI = confidence interval; NNT = number needed to treatARR = absolute risk reduction; CI = confidence interval; NNT = number needed to treatAddress correspondence to Jason M. Corbo, PharmD, BCPS, at jason.
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