Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review
Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review
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DOI：
10.1136/bmj.38237.585000.7c
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发表时间：
2004-10-09
影响因子：
105.7
通讯作者：
Craig, JC
中科院分区：
文献类型：
--
作者：
Strippoli, GFM;Craig, M;Craig, JC
目的评价血管紧张素转换酶（ACE）抑制剂和血管紧张素H受体拮抗剂（AIIRAs）对糖尿病肾病（DN）患者肾脏转归和全因死亡率的影响。研究选择在糖尿病患者中比较ACE抑制剂或AIIRA与安慰剂或彼此之间的试验肾病。数据提取死亡率，肾脏结局（终末期肾病、血清肌酐浓度加倍、预防微量白蛋白尿进展为大量白蛋白尿、缓解微量白蛋白尿）和试验质量。数据综合43项确定的试验中有36项比较了ACE抑制剂与安慰剂4例患者（4008例患者）比较了AIIRA与安慰剂（3331例患者），3例患者比较了ACE抑制剂与AIIRA（206例患者）。我们获得了11项试验的未发表数据。与安慰剂相比，ACE抑制剂显著降低了全因死亡率（相对风险0.79，95%置信区间0.63 - 0.99），但AIIRA没有（0.99，0.85 - 1.17），尽管试验中基线死亡率相似。两种药物对肾脏结局的影响相似。ACE抑制剂与AIIRAs相比的无混淆的相对影响的可靠估计不能获得由于小样本sizes.Conclusion虽然ACE抑制剂对糖尿病肾病患者的生存益处是已知的，ACE抑制剂和AIIRAs对生存的相对影响是未知的，由于缺乏足够的头对头试验。
Objective To evaluate the effects of angiotensin converting enzyme (ACE) inhibitors and angiotensin H receptor antagonists (AIIRAs) on renal outcomes and all cause mortality in patients with diabetic nephropathy.Data sources, Medline, Embase, the Cochrane controlled trials register, conference proceedings, and contact with investigators.Study selection Trials comparing ACE inhibitors or AIIRAs with placebo or with each other in patients with diabetic nephropathy.Data extraction Mortality, renal outcomes (end stage renal disease, doubling of serum creatinine concentration, prevention of progression of microalbuminuria to macroalbuminuria, remission of microalbuminuria), and quality of trials.Data synthesis 36 of 43 identified trials compared ACE inhibitors with placebo (4008 patients), four compared AIIRAs with placebo (3331 patients), and three compared ACE inhibitors with AIIRAs (206 patients). We obtained unpublished data for 11 trials. ACE inhibitors significantly reduced all cause mortality (relative risk 0.79, 95% confidence interval 0.63 to 0.99) compared with placebo but AIIRAs did not (0.99, 0.85 to 1.17), although baseline mortality was similar in the trials. Both agents had similar effects on renal outcomes. Reliable estimates of the unconfounded relative effects of ACE inhibitors compared with AIIRAs could not be obtained owing to small sample sizes.Conclusion Although the survival benefits of ACE inhibitors for patients with diabetic nephropathy are known, the relative effects of ACE inhibitors and AIIRAs on survival are unknown owing to the lack of adequate head to head trials.