Renoprotective effect of angiotensin receptor blockers beyond their BP lowering effect in patients with hypertension and chronic kidney disease: A systematic review and meta-analysis

Burnier M , Ruilope L , Lin S , Bader G , Durg S , Lin D , Brunel P

Abstract

Objectives: Angiotensin receptor blockers (ARBs) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). We evaluated the effect of ARB treatment on renal parameters, beyond blood pressure (BP) control, in patients with hypertension and CKD. Methods: A literature search was performed using MEDLINE, EMBASE, and BIOSIS to identify randomized controlled trials (≥8 weeks) in adults with hypertension and CKD that reported the effect of ARBs on systolic/diastolic BP (SBP/DBP), glomerular filtration rate (GFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria. Meta-analysis (post- vs pre-treatment) was conducted in R-statistical software (v3.4.1) using a meta-package. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) were used to report an outcome. Results: Of the 20 studies identified, 15 evaluated ARBs as monotherapy, 4 evaluated ARBs in combination with other antihypertensives, and 1 evaluated ARBs both as mono- and combination therapy. ARB monotherapy significantly (P < 0.01) reduced proteinuria (≥8 weeks to < 1 year [MD; 95% CI: −0.6; −0.9 to −0.3; ≥1 year [−0.9; − 1.2 to − 0.6]); this was consistent for ARBs as combination therapy (Figure). No significant changes in eGFR, CrCl or SCr levels were observed with ARBs during this treatment exposure range. Further, ARB monotherapy significantly (P < 0.01) reduced mean SBP (MD: − 12.6; 95% CI, − 18.5 to − 6.7)/DBP (−6.5; − 11.3 to − 1.8) for ≥8 weeks to <1 year and for ≥1 year (SBP [−15.9; − 21.4 to − 10.3]/DBP [−11.6; − 15.9 to − 7.3]).Conclusion: ARB treatment showed a renoprotective effect by reducing proteinuria, in addition to BP reduction, thus demonstrating their beneficial role in patients with hypertension and CKD.

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