The Pharmaceutical Journal
Vol 275 No 7380 p737
17 December 2005

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News summary

ACE inhibitors and ARBs not always best in kidney disease

Angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers are not necessarily better than other antihypertensives in preventing kidney disease, a review of evidence suggests (Lancet 2005;366:2026).

Researchers from University College London looked at data from 127 randomised controlled trials to investigate whether there is evidence to support national and international guidelines which endorse the first-line use of these agents in patients with diabetic and non-diabetic nephropathy.

The researchers say that benefits of ACE inhibitors and ARBs on renal outcomes in placebo-controlled trials probably result from a blood-pressure lowering effect. In trials that compared the drugs with other antihypertensives there appeared to be “no significant salutary effect” on renal outcomes, they add.

“Treatment decisions for hypertension in renal disease should be based on the blood-pressure lowering effect, comparative tolerability, and cost of antihypertensive treatment,” the researchers conclude.