Antiproteinuric effect of angiotensin receptor blockers in normotensive patients with proteinuria: A meta-analysis of randomized controlled trials

Abstract

Introduction: The objective of this article is to evaluate the antiproteinuric effect of angiotensin receptor blockers (ARBs) in normotensive patients with proteinuria. Materials and methods:We reviewed randomized controlled trials assessing ARBs treatment in patients with normotension and proteinuria. Data concerning the study design, patient characteristics, and outcomes were extracted. Ratio of means was calculated by using the generalized inverse variance method. Results: Eight trials involving 866 patients were included in this study. Compared with a control group, ARBs group was associated with a significant reduction in urinary protein excretion (ratio of means 0.53, 95% CI 0.44-0.64). Subgroup analysis shows that ARBs therapy resulted in a significant decrease in urinary protein excretion in diabetic patients with microalbuminuria or nondiabetic nephropathy with overt proteinuria (ratio of means 0.57, 95% CI 0.47-0.69 and 0.46, 95% CI 0.26-0.83, respectively), in a Western population or an Asian population (ratio of means 0.61, 95% CI 0.54-0.69 and 0.49, 95% CI 0.37-0.64, respectively), and in patients followed up for one to three months or three to 12 months (ratio of means 0.62, 95% CI 0.54-0.70 and 0.49, 95% CI 0.38-0.63, respectively). Conclusions:The data suggest that ARBs may have beneficial effects in preventing the progression of proteinuria in normotensive patients with renal disease.

The renin‐angiotensin‐aldosterone system and its suppression

“…Proteinuria, a marker of kidney injury, is likely a predictor of increased risk for disease progression, and might play a causal role in progression of glomerular disease . Clinical trials involving RAAS suppression in people with proteinuric kidney disease are summarized in Supporting Information Table S5.…”

Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años

“…In DMT2 patients with normal blood pressure, treatment with ARA II also reduced urinary excretion of albumin (relation of means= 0.57; CI 95%= 0.47-0.69) 67 . A similar effect can be hoped for with use of ACEI 68 .…”

Comparative proteinuria management of different angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for normotensive patients with CKD: a Bayesian network meta-analysis

“…A 2012 meta-analysis comparing ACEI therapy with placebo showed a significant reduction in macroalbuminuria in diabetic patients without hypertension and a trend towards a benefit from the combination therapy of ACEI and ARB (Lv et al, 2012). Another, 2014 meta-analysis noted that ARBs have beneficial effects on reducing proteinuria in normotensive patients with renal disease (Geng et al, 2014). Our study also showed that all the treatments with ACEI, ARB or both lessened proteinuria significantly more than placebo in normotensive CKD patients, not merely in diabetic nephropathy patients.…”

“…Indeed, some patients present merely proteinuria without hypertension clinically, especially among the early CKD patients. A previous meta-analysis (Geng et al, 2014) suggested that compared with the placebo group, the ARB group had a significant reduction in urinary protein excretion and better renoprotective effects in normotensive patients with CKD, but it did decrease both diastolic and systolic blood pressure. The reduction in blood pressure in normotensive patients may sometimes result in hypotension.…”