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Antihypertensive Drugs Offer Limited Renoprotection

Meta-analysis shows blood-pressure reduction may be only renoprotective effect in patients with renal disease

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MONDAY, Dec. 12 (HealthDay News) -- Beyond lowering blood pressure, antihypertensive drugs may have no additional renoprotective effects in either diabetic or non-diabetic patients with renal disease, according to a study in the Dec. 10 issue of The Lancet.

Juan Casas, M.D., of University College London, U.K., and colleagues reviewed randomized trials assessing the effects of angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs) and other antihypertensive drugs on the progression of renal disease.

When comparing the effects of ACE inhibitors or ARBs with other antihypertensive drugs, the researchers calculated a relative risk of 0.71 for doubling of creatinine and found a small benefit on end-stage renal disease. "In patients with diabetic nephropathy, no benefit was seen in comparative trials of ACE inhibitors or ARBs on the doubling of creatinine, end-stage renal disease, glomerular filtration rate, or creatinine amounts," the authors write. "Placebo-controlled trials of ACE inhibitors or ARBs showed greater benefits than comparative trials on all renal outcomes, but were accompanied by substantial reductions in blood pressure in favor of ACE inhibitors or ARBs," they add.

"The benefits of ACE inhibitors or ARBs on renal outcomes in placebo-controlled trials probably result from a blood-pressure-lowering effect," the authors conclude. "In patients with diabetes, additional renoprotective actions of these substances beyond lowering blood pressure remain unproven."

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