Horm Metab Res 2020; 52(05): 289-297
DOI: 10.1055/a-1138-0959
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Effects of ACE Inhibitors and Angiotensin Receptor Blockers in Normotensive Patients with Diabetic Kidney Disease

Dandan He
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Yaru Zhang
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Wei Zhang
2   Department of Cardiac Surgery, Tianjin Chest Hospital, China
,
Yue Xing
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Yipeng Guo
3   Department of Epidemiology, Tianjin Public Health Bureau, Tianjin, China
,
Fuzhen Wang
4   Department of Statistics, Fenyang Hospital of Shanxi Province, Fenyang, China
,
Junya Jia
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Tiekun Yan
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Youxia Liu
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
,
Shan Lin
1   Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China
› Author Affiliations

Funding This work was supported by grants from the National Natural Science Foundation (81600553, 81270791, and 30800529), Tianjin Municipal Science and Technology Commission Foundation (14JCYBJC27900) and Tianjin Public Health Bureau Foundation (2014KR16), The 12th Five-Year Plan National Science and Technology Support Program (No. 2011BAI10B02) and Shanxi Public Health Bureau Foundation (201302051), the General Hospital of Tianjin Medical University Youth Incubation Foundation (ZYYFY2015001).
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Publication History

received 19 December 2018

accepted 10 March 2020

Publication Date:
27 March 2020 (online)

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Abstract

The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing the progression of albuminuria and risk of cardiovascular events in hypertensive patients with diabetic kidney disease (DKD) is well-documented. However, the efficacy and safety of these agents in normotensive patients with DKD are still controversial. MEDLINE, Embase, and Cochrane Library were searched for relevant random controlled trials. The odd risk (OR) reductions were calculated with a random-effects model. Decrease in albuminuria, changes in eGFR, major cardiovascular events, and drug-related adverse events were analyzed. Thirteen RCTs including 1282 patients were retrieved. Compared with placebo or other active agent groups, ACEIs or ARBs significantly decreased albuminuria (MD –80.28 mg/d, 95% CI –104.79 mg/d to –55.77 mg/d), and the efficacy is independent of changes in blood pressure and systolic blood pressure at baseline. The result of subanalysis showed the declining of albuminuria was more significantly in normotensive DKD patients with 2DM (p=0.005). No significant differences were found with regard to the declining of evaluated glomerular filtration rate (eGFR) (MD –0.29 ml/min/1.73 m2, 95% CI –2.99 to 2.41 ml/min/1.73 m2). There were no significant differences in the side effect of the drugs such as hypotension and hyperkalemia. This meta-analysis demonstrated that ACEIs or ARBs can decrease albuminuria to varying degree in normotensive patients with DKD, and better response occurred in patients with 2DM.

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