In a nutshell
This review analyzed different studies that evaluated the effect of antihypertensive agents (blood pressure-lowering drugs) on the onset and progress of diabetic kidney disease (DKD).
Some background
Diabetes mellitus (DM) is a condition which increases blood sugar levels in the body. Cardiovascular diseases (CVD), such as hypertension (high blood pressure), are often associated with DM. Kidney injury (referred to as DKD or diabetic nephropathy) is also a major complication of untreated diabetes. Hypertension is considered a major risk factor for DKD. A urine test for a protein called albumin is used to follow the development of DKD. The treatment of DKD is focused primarily on the reduction of blood glucose levels and blood pressure. Commonly used anti-hypertensive drugs include angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs) and angiotensin II receptor antagonists (ARBs).
Methods & findings
This review analyzed 26 studies with a total of 61,264 DM patients. None of these patients suffered from DKD when joining the studies. These trials included both patients suffering from hypertension, and patients with normal blood pressure. The effects of anti-hypertensive drugs were compared to a placebo (a substance with no therapeutic effect), or compared to one another. The outcomes reviewed were changes in urine albumin (indicative of DKD), survival rate, blood pressure measurements and adverse events to treatment.
The results showed that ACEIs reduced the risk of DKD by 29% when compared to a placebo. ARBs and CCBs did not show a significant effect on urine albumin levels. ACEIs also improved survival by 18.5% as compared to a placebo. ARBs did not show a significant effect in the survival rate. All anti-hypertensive agents showed a reduction in blood pressure levels. However, ACEIs were related to more adverse events such as development of a cough.
The bottom line
This review found that ACEIs were the most effective in improving survival and preventing DKD in patients with DM. This was also proven true for patients with normal blood pressure, and not only for those suffering from hypertension.
The fine print
A few of the studies reviewed here did not report complete results, and some were not preformed in a "double blind" manner (when neither doctor, nor patient, know which drug each patient is receiving). However, since this research included a very large number trials and patients, this is of less significance. Statistically speaking, this study is very reliable.
What’s next?
Consult with your physician on how to reduce your risk for diabetic complications such as DKD.
Published By :
Cochrane database of systematic reviews
Date :
Dec 12, 2012
