New Finding on Antihypertensive Therapy

Lowering blood pressure may be more important than the specific choice of an antihypertensive agent in patients with renal disease, according to a new study.

The current guidelines recommending the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) for patients with renal disease are not supported by available evidence, according to the results of a meta-analysis conducted by Dr. Juan P. Casas, M.D., and colleagues from University College London Hospitals (London, United Kingdom). The finding was reported in the December 10, 2005, issue of The Lancet.

The investigators searched electronic databases up to January 2005 for randomized trials evaluating the effects of antihypertensive drugs on the progression of renal disease. They found that current practice guidelines for hypertension in the United Kingdom, United States, and Europe recommend the use of ACEI and ARB as first-line therapy in patients with diabetic and nondiabetic nephropathy to retard the progression of renal disease.

The authors concluded that there seems to be little justification for ACEI or ARB to be a first-line choice for renoprotection in diabetics on the basis of efficacy, and residual uncertainty still exists about the inherent value of these drugs in other renal disorders. In patients with diabetes, additional renoprotective actions of these substances beyond lowering blood pressure remain unproven.

"The benefits of ACEI or ARB on renal outcomes in placebo-controlled trials probably result from a blood-pressure-lowering effect,” the authors write. "In view of the present analysis, treatment decisions for hypertension in renal disease should be based on the blood-pressure-lowering effect, comparative tolerability, and cost of antihypertensive treatment.”



Related Links:
The Lancet
University College London Hospitals