המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-16 17:01:05 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – ACE inhibitors should be the antihypertensive agents of first choice in patients with nondiabetic renal disease, investigators suggest based on a meta-analysis of 11 randomized controlled trials.
Included in the analysis by Dr. Andrew S. Levey of the New England Medical Center in Boston and members of the ACE Inhibition in Progressive Renal Disease Study Group were 941 patients assigned to ACE inhibitors and 919 assigned to control groups. Patients in both groups used other antihypertensive medications to maintain blood pressure below 140/90 mm Hg.
During a mean followup of 2.2 years, those in the ACE inhibitor groups exhibited significantly greater decreases in systolic blood pressure, diastolic blood pressure and urine protein excretion (P<0.001 for all three measures) than those in the control groups.
Among those taking ACE inhibitors, 7.4% developed end-stage renal disease, compared with 11.6% of the control patients (P=0.002). The beneficial effect of ACE inhibitors was greater at higher baseline urinary protein excretion.
Dr. Levey's group suggests in the Annals of Internal Medicine for July 17 that ACE inhibitors may also be of benefit in patients with chronic renal disease in the absence of hypertension or elevated serum creatinine concentrations.
Dr. Robert W. Schrier, of the University of Colorado Health Sciences Center, and Raymond O. Estacio, of Denver Health, call the group's recommendation "an exciting hypothesis," but caution that it must be considered tentative.
In an interview with Reuters Health, Dr. Schrier said that, although the meta-analysis "supports the role of ACE inhibitors," to make a clear-cut statement requires "a well designed, prospective, randomized study, with enough statistical power, followed for a sufficient period of time."
"There are a bunch of types of non-diabetic kidney disease, whether you're talking about focal segmental glomerulonephritis, proliferative glomerulonephritis, polycystic kidney disease, or IgA nephropathy," he added. "To say that for every type of renal disease you use an ACE inhibitor, I don't think we're there yet. I think there should be a voice of hesitation."
Ann Intern Med 2001;135:73-87,138-139.
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