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Siebenhofer, A; Plank, J; Horvath, K; Berghold, A; Sutton, AJ; Sommer, R; Pieber, TR.
Angiotensin receptor blockers as anti-hypertensive treatment for patients with diabetes mellitus: meta-analysis of controlled double-blind randomized trials.
DIABETIC MED. 2004; 21(1): 18-25. Doi: 10.1111/j.1464-5491.2004.01122.x
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Leading authors Med Uni Graz: Siebenhofer-Kroitzsch Andrea
Co-authors Med Uni Graz: Berghold Andrea; Horvath Karl; Pieber Thomas
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Abstract:: AIMS: To assess the evidence for possible reduction of all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease in diabetic patients treated with angiotensin II type 1 receptor blockers (ARBs) as an anti-hypertensive treatment. METHODS: Systematic review and meta-analysis of randomized, double-blind controlled trials of at least 1 year's duration. ARBs were used in the intervention group vs. placebo or standard anti-hypertensive treatment in the control group. The main outcome measures were all-cause mortality, cardiovascular morbidity and mortality, and end-stage renal disease. RESULTS: Three studies fulfilled the inclusion criteria. Separate analyses were conducted for comparisons of ARBs with groups given placebo and those given standard anti-hypertensive treatment. There was no significant difference in mortality between the ARBs and placebo groups, with an estimated odds ratio (OR) of 0.99 [95% confidence interval (CI) 0.81, 1.20]. There was a non-significant difference in patients treated with ARBs compared with standard anti-hypertensive treatment, with an OR of 0.78 (95% CI 0.45, 1.36). No statistically significant difference in cardiovascular morbidity and mortality between the intervention and placebo groups was found, with an OR of 0.91 (95% CI 0.77, 1.08). When ARBs were compared with standard treatment, the OR was estimated at 0.85 (0.54, 1.33). Data on end-stage renal disease were available for two studies comparing ARBs vs. placebo and showed a statistically significant advantage of ARBs, with an OR of 0.73 (95% CI 0.6, 0.89). As only one study compared end-stage renal disease outcome for ARBs vs. standard treatment, a meta-analysis was not possible. This study reported a considerable benefit of ARBs [OR = 0.73 (0.54, 1.01)] compared with the calcium channel blocker amlodipine. CONCLUSIONS: ARBs failed to show significant reduction in total mortality and cardiovascular morbidity and mortality in diabetic patients. The only statistical benefit was the reduction of end-stage renal disease compared with placebo. Therefore, at this time ARBs have not proved to be superior to standard anti-hypertensive treatment in diabetic patients.
Find related publications in this database (using NLM MeSH Indexing): Angiotensin II - metabolism; Angiotensin II Type 1 Receptor Blockers - metabolism; Antihypertensive Agents - therapeutic use; Diabetic Angiopathies - mortality; Diabetic Nephropathies - mortality; Double-Blind Method - mortality; Humans - mortality; Kidney Failure, Chronic - mortality; Morbidity - mortality; Randomized Controlled Trials - mortality
Find related publications in this database (Keywords): diabetes; angiotensin receptor blockers; meta-analysis