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Effect of Antihypertensive Therapy on the Kidney in Patients with Diabetes: A Meta-Regression Analysis

Bertram L. Kasiske, MD; Roberto S. N. Kalil, MD; Jennie Z. Ma, MS; Minjen Liao, MD; and William F. Keane, MD
[+] Article and Author Information

From Hennepin County Medical Center, Minneapolis, Minnesota. Requests for Reprints: Bertram L. Kasiske, MD, Division of Nephrology, Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415. Acknowledgments: The authors thank Ms. Jan Lovick and Ms. Dee Lunzer for help in preparing the manuscript; and Thomas Louis, PhD, Chairman, Department of Biostatistics, University of Minnesota, for helpful suggestions and guidance.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(2):129-138. doi:10.7326/0003-4819-118-2-199301150-00009
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Objective: To assess the relative effect of different antihypertensive agents on proteinuria and renal function in patients with diabetes.

Data Sources: We used MEDLINE and bibliographies in recent articles to identify studies of the effects of antihypertensive agents on renal function in patients with diabetes.

Study Selection: We selected 100 controlled and uncontrolled studies that provided data on renal function, proteinuria, or both, before and after treatment with an antihypertensive agent.

Data Extraction: Data on blood pressure, renal function, proteinuria, patient characteristics (for example, age, sex, and type of diabetes), and study design (for example, random allocation and the use of a placebo) were extracted from selected studies.

Data Synthesis: Multiple linear regression analysis indicated that angiotensin-converting enzyme (ACE) inhibitors decreased proteinuria independent of changes in blood pressure, treatment duration, and the type of diabetes or stage of nephropathy, as well as study design (P < 0.0001). Reductions in proteinuria from other antihypertensive agents could be entirely explained by changes in blood pressure. Blood pressure reduction in itself was associated with a relative increase in glomerular filtration rate (regression coefficient [±SE], 3.70 ±.92 mL/min for each reduction of 10 mm Hg in mean arterial pressure; P = 0.0002); however, compared with other agents, ACE inhibitors had an additional favorable effect on glomerular filtration rate that was independent of blood pressure changes (3.41 ± 1.71 mL/min; P = 0.05).

Conclusion: Angiotensin-converting enzyme inhibitors can decrease proteinuria and preserve glomerular filtration rate in patients with diabetes. These effects occur independent of changes in systemic blood pressure.

Figures

Grahic Jump Location
Figure 1.
The change in mean arterial blood pressure for each experimental group included in the regression analysis.

Not shown are three groups that received combination therapy with an angiotensin-converting enzyme inhibitor and a calcium antagonist, two groups that received an angiotensin-converting enzyme inhibitor plus a β-blocker, and one group that received a calcium antagonist plus a β-blocker. Bars represent 95% CIs.

Grahic Jump Location
Grahic Jump Location
Figure 2.
The change in glomerular filtration rate for each experimental group included in the regression analysis.

Not shown is one group that received combination therapy with an angiotensin-converting enzyme inhibitor and a calcium antagonist and one group that received combination therapy with a calcium antagonist and a β-blocker. Bars represent 95% CIs.

Grahic Jump Location
Grahic Jump Location
Figure 3.
The change in urine protein excretion for each experimental group included in the regression analysis.

Not shown is one group that received combination therapy with an angiotensin-converting enzyme inhibitor and a calcium antagonist. ln (treatment/baseline) = ln (treatment) − ln (baseline).

Grahic Jump Location

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