The purpose of this meta-analysis was to evaluate the controversy of angiotensin-converting enzyme inhibitor (ACEI) in combination with angiotensin-receptor blocker (ARB) in the treatment of chronic kidney disease (CKD) based on dose. PubMed, EMBASE, and Cochrane Library were searched to identify randomized controlled trials (RCTs) from inception to March 2020. The random effects model was used to calculate the effect sizes. Potential sources of heterogeneity were detected using sensitivity analysis and meta-regression. This meta-analysis of 53 RCTs with 6,375 patients demonstrated that in patients with CKD, ACEI in combination with ARB was superior to low-dose ACEI or ARB in reducing urine albumin excretion (SMD, -0.43; 95% CI, -0.67 to -0.19; = 0.001), urine protein excretion (SMD, -0.22; 95% CI, -0.33 to -0.11; < 0.001), and blood pressure (BP), including systolic BP (WMD, -2.89; 95% CI, -3.88 to -1.89; < 0.001) and diastolic BP (WMD, -3.02; 95% CI, -4.46 to -1.58; < 0.001). However, it was associated with decreased glomerular filtration rate (GFR) (SMD, -0.13; 95% CI, -0.24 to -0.02; = 0.02) and increased rates of hyperkalemia (RR, 2.07; 95% CI, 1.55 to 2.76; < 0.001) and hypotension (RR, 2.19; 95% CI, 1.35 to 3.54; = 0.001). ACEI in combination with ARB was more effective than high-dose ACEI or ARB in reducing urine albumin excretion (SMD, -0.84; 95% CI, -1.26 to -0.43; < 0.001) and urine protein excretion (SMD, -0.24; 95% CI, -0.39 to -0.09; = 0.002), without decrease in GFR (SMD, 0.02; 95% CI, -0.12 to 0.15; = 0.78) and increase in rate of hyperkalemia (RR, 0.94; 95% CI, 0.65 to 1.37; = 0.76). Nonetheless, the combination did not decrease the BP and increased the rate of hypotension (RR, 3.95; 95% CI, 1.13 to 13.84; = 0.03) compared with high-dose ACEI or ARB. ACEI in combination with ARB is superior in reducing urine albumin excretion and urine protein excretion. The combination is more effective than high-dose ACEI or ARB without decreasing GFR and increasing the incidence of hyperkalemia. Despite the risk of hypotension, ACEI in combination with ARB is a better choice for CKD patients who need to increase the dose of ACEI or ARB PROSPERO CRD42020179398).
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134749 | PMC |
| http://dx.doi.org/10.3389/fphar.2021.638611 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
A Five-Year Prospective, Randomized, Open-Label Study of Standard-Dose Versus Low-Dose Prolonged-Release Tacrolimus With or Without Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Post Kidney Transplantation.
Clin Transplant
January 2025
Department of Internal Medicine and Immunology, Health Sciences Centre, Winnipeg, Manitoba, Canada.
Introduction: Novel approaches to improve long-term outcomes in kidney transplant recipients are required. Here, we present the 5-year data from a multicenter, prospective, Phase 3b trial evaluating treatment outcomes with standard (STD) or low (LOW) dose prolonged-release tacrolimus (TAC) combined with ACEi/ARB or other antihypertensive therapy (OAHT) in Canadian kidney transplant recipients.
Methods: Adult de novo kidney transplant recipients were randomized 2 × 2 to STD or LOW dose TAC and ACEi/ARB or OAHT.
Osteoporotic fracture risks of thiazides and dihydropyridines in angiotensin modulator users.
Osteoporos Int
December 2024
Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan.
Unlabelled: This study examined the impact of thiazide and RAAS antihypertensive medications vs DHP-RAAS medications on fracture risk. The close alignment of such settings with clinical use, combined with the potential bone benefits of ACEis and ARBs, provides enhanced accuracy in bone health evidence.
Purpose: To determine whether thiazides, combined with either angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB), offer bone-protective benefits compared with dihydropyridine (DHP) drugs combined with ACEi or ARB.
Role of physiological ischemia training in suppressing ventricular remodeling and ventricular arrhythmia in patients after myocardial infarction: a randomized controlled trial.
Am J Transl Res
November 2024
Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University Suzhou 215200, Jiangsu, China.
Objectives: The randomized controlled study explored whether physiological ischemia training (PIT) can inhibit ventricular remodeling and reduce ventricular arrhythmias in the early period of acute myocardial infarction (AMI).
Methods: AMI patients with hypotension or bradycardia were randomly divided into PIT (n = 21) and control (n = 20) groups. Meanwhile, patients with normal blood pressure (BP) and heart rate (HR) were randomly divided into PIT+angiotensin-converting enzyme inhibitor (ACEI) and/or β-blocker (AB) (n = 30) and AB (n = 30) groups.
Evaluation of Prescription Pattern of Antihypertensives and Its Compliance with Joint National Committee 8 Guidelines in Hospital Setting.
J Assoc Physicians India
December 2024
Senior Consultant, Interventional Cardiologist, and Electrophysiologist, Department of Cardiology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India.
Globally, hypertension is a major noncommunicable disease that contributes to significant fatalities and morbidity. Evaluation of trends in the prescription of antihypertensives and their adherence to the Joint National Commission 8 (JNC 8) recommendations can provide perspective on the dissemination of local and international guidelines in real-world clinical practice. An ambispective observational study was conducted over a duration of 6 months.
View Article and Find Full Text PDFImpact of Renin-Angiotensin System Inhibitors on Response to PD1/L1 Inhibitors in Patients With Metastatic Renal Cell Carcinoma.
Clin Genitourin Cancer
November 2024
University of Virginia, Division of Hematology and Oncology. Electronic address:
Article Synopsis
- The renin-angiotensin-aldosterone system (RAAS) has implications beyond blood pressure regulation and may impact cancer development and treatment outcomes, particularly in metastatic renal cell carcinoma (mRCC).
- A study at the University of Virginia showed that patients with mRCC receiving immunotherapy (IO) who also used RAASI, like ACE inhibitors or ARBs, experienced higher rates of tumor regression.
- The research suggests a significant association between concurrent RAASI use and tumor regression among patients undergoing IO, indicating potential benefits of combining these treatments in managing mRCC.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!