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ARBs Found Ineffective for Renal Function in Diabetes

Two angiotensin receptor blockers do not improve renal outcomes compared with placebo

THURSDAY, May 21 (HealthDay News) -- Two angiotensin receptor blockers are ineffective in reducing renal dysfunction in patients at high risk of vascular disease such as diabetics, according to two studies published online May 19 in the Annals of Internal Medicine.

In the first study, Johannes F. E. Mann, M.D., from Ludwig-Maximilians-University in Munich, Germany, and colleagues randomly assigned 5,927 patients with cardiovascular disease or diabetes, but without macroalbuminuria or heart failure who could not tolerate angiotensin-converting enzyme inhibitors, to placebo or the angiotensin receptor blocker telmisartan plus standard treatment. Over a mean of 56 months, they found that the effect of telmisartan on individual renal parameters was mixed, but the composite renal outcome (dialysis, doubling of serum creatinine, changes in estimated glomerular filtration rate, and changes in albuminuria) was similar in both groups.

In the second study, Rudy Bilous, M.D., from Newcastle University in the United Kingdom, and colleagues randomly assigned 3,326 and 1,905 patients with type 1 and type 2 diabetes, respectively, normoalbuminuria, and mostly normotensive to placebo or the angiotensin receptor blocker candesartan. During a median of 4.7 years, they found that both groups had a similar risk of microalbuminuria.

"In the DIRECT-Renal analysis, candesartan had no effect on incidence of microalbuminuria over 4.7 years in a study sample of normoalbuminuric and normotensive patients with type 1 diabetes and normoalbuminuric patients with type 2 diabetes with or without treated hypertension," Bilous and colleagues conclude.

The first study was supported by Boehringer Ingelheim. Many of the authors reported financial relationships with pharmaceutical companies, including Boehringer Ingelheim. The second study was funded by AstraZeneca and Takeda. Many of the authors reported consultant or financial relationships with pharmaceutical companies, including AstraZeneca and Takeda.

Abstract - Mann
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Abstract - Bilous
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