Abstract
The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin
receptor blockers (ARBs) in reducing the progression of albuminuria and risk of
cardiovascular events in hypertensive patients with diabetic kidney disease
(DKD) is well-documented. However, the efficacy and safety of these agents in
normotensive patients with DKD are still controversial. MEDLINE, Embase, and
Cochrane Library were searched for relevant random controlled trials. The odd
risk (OR) reductions were calculated with a random-effects model. Decrease in
albuminuria, changes in eGFR, major cardiovascular events, and drug-related
adverse events were analyzed. Thirteen RCTs including 1282 patients were
retrieved. Compared with placebo or other active agent groups, ACEIs or ARBs
significantly decreased albuminuria (MD –80.28 mg/d,
95% CI –104.79 mg/d to
–55.77 mg/d), and the efficacy is independent of changes
in blood pressure and systolic blood pressure at baseline. The result of
subanalysis showed the declining of albuminuria was more significantly in
normotensive DKD patients with 2DM (p=0.005). No significant differences
were found with regard to the declining of evaluated glomerular filtration rate
(eGFR) (MD
–0.29 ml/min/1.73 m2,
95% CI –2.99 to
2.41 ml/min/1.73 m2). There were
no significant differences in the side effect of the drugs such as hypotension
and hyperkalemia. This meta-analysis demonstrated that ACEIs or ARBs can
decrease albuminuria to varying degree in normotensive patients with DKD, and
better response occurred in patients with 2DM.
Key words
diabetic kidney disease - angiotensin-converting enzyme inhibitors - angiotensin receptor
blockers - albuminuria - cardiovascular events - meta-analysis
