Which Blood Pressure-Lowering Strategy for Patients with Diabetes and Chronic Kidney Disease?
By Amy Orciari Herman
Edited by
- Jaye Elizabeth Hefner, MD
Findings from a network meta-analysis in the Lancet may help guide decisions regarding blood pressure-lowering therapy in patients with diabetes and chronic kidney disease (CKD).
Researchers examined nearly 160 randomized trials that compared different BP-lowering regimens in over 40,000 adults with diabetes (mostly type 2) and CKD. They found that no drug was better than placebo in terms of survival. ACE inhibitors, angiotensin-receptor blockers (ARBs), and endothelin inhibitors were most effective for preventing end-stage renal disease; however, only ARBs were significantly superior to placebo (odds ratio with ARB alone, 0.77; with ARB + ACE inhibitor, 0.62).
ACE inhibitor plus ARB combination therapy was associated with a "borderline" increased risk for hyperkalemia and acute kidney injury. The authors estimate that for every 1000 patients who receive this combination for 1 year, 14 patients might avoid end-stage kidney disease and 208 may have regression of albuminuria -- but 55 could develop acute kidney injury, and 135 could experience hyperkalemia. (The benefits and harms after 1 year of ARB monotherapy were lower.)
