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Does Evidence Support Renin–Angiotensin System Blockade for Slowing Nephropathy Progression in Elderly Persons?

Pantelis A. Sarafidis, MD, MSc, PhD; and George L. Bakris, MD
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From AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54006, Greece; and University of Chicago, Pritzker School of Medicine, Chicago, IL 60637.

Potential Financial Conflicts of Interest:Consultancies: G.L. Bakris (Abbott, Takeda, GlaxoSmithKline, Boehringer Ingelheim, Gilead, Novartis, Merck & Co.). Grants received: G.L. Bakris (National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, GlaxoSmithKline, Forest, Juvenile Diabetes Foundation). Grants pending: G.L. Bakris (National Institutes of Health, Alternative Medicine Institute).

Requests for Single Reprints: George L. Bakris, MD, University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637; e-mail, gbakris@gmail.com.

Current Author Addresses: Dr. Sarafidis: AHEPA Hospital, Aristotle University of Thessaloniki, First Kiriakidi Street, Thessaloniki 54006, Greece.

Dr. Bakris: University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637.

Ann Intern Med. 2009;150(10):731-733. doi:10.7326/0003-4819-150-10-200905190-00014
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Authoritative practice guidelines recommend agents that block the renin–angiotensin system (RAS) as first-line therapy for patients with chronic kidney disease (CKD) (13). The evidence to support these recommendations comes from more than 2 decades of studies, as well as from several randomized trials demonstrating that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers slow CKD progression more effectively than other antihypertensive agents (46). All of these nephropathy outcome trials define “benefit” as a slowed time to doubling of serum creatinine level, dialysis, or death.

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