No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.1
Researchers analysed 157 studies comparing blood pressure lowering agents in a total of 43 256 patients with diabetic kidney disease, mostly type 2 diabetes and chronic kidney disease. The trials were identified by searching electronic databases systematically for trials published up to January 2014 that compared several classes of blood pressure lowering drugs, used alone or in combination, with placebo in adults who had diabetes and kidney disease.
Results showed that no drug regimen was more effective than placebo in reducing all cause mortality. Odds ratios ranged from 0.36 (95% confidence interval 0.12 to 1.05) with the highest ranked strategy (ACE inhibitor plus calcium channel blocker) to 5.13 (0.81 to 32.4) with the lowest ranked agent (beta blocker).
Progression to end stage renal disease was significantly less likely with a combination of an angiotensin receptor blocker (ARB) and an ACE (angiotensin converting enzyme) inhibitor than with placebo (0.62 (0.43 to 0.90)). However, this combination was associated with increased risks of hyperkalaemia and acute kidney injury. Treating 1000 patients with dual ACE inhibitor and ARB treatment for a year would pre...