ACE inhibitors for high blood pressure prevent kidney disease and death in people with diabetes and normal kidney function

Lv J, Perkovic V, Foote CV, et al. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev. 2012:12:CD-004136.

Review question

What are the effects of blood pressure–lowering drugs in preventing diabetic kidney disease?

Background

End-stage kidney disease occurs when the kidneys no longer work at the level needed for daily life.

The most common causes of end-stage kidney disease are diabetes and high blood pressure.

People with diabetes who develop kidney disease are at increased risk of kidney failure, heart and circulatory problems, and death.

If blood pressure rises and stays high over time, it can damage the body in many ways.

How the review was done

This report is an update of a Cochrane Systematic Review first published in 2003 and updated in 2005.

This summary is based on a systematic review of 26 randomized controlled trials published since 2005. Studies included 61,264 adults. Follow-up ranged from 6 to 78 months (average of about 43 months).

Types of blood pressure–lowering medications studied were angiotensin-converting enzyme inhibitors (or ACE inhibitors), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, and diuretics.

Medications were studied alone, in combination, or compared with placebo.

What the researchers found

Compared with placebo, ACE inhibitors

• reduced the risk of diabetic kidney disease by 29%. Similar benefits occurred in people with and without high blood pressure and also when compared with calcium channel blockers.
• reduced the risk of dying by 16%.
• increased the risk of cough by 84%.

There were no differences in the risk of headache or elevated potassium in the blood (which is more likely to happen when the kidneys are not working properly).

Compared with placebo, angiotensin-receptor blockers

• did not reduce the risk of diabetic kidney disease or dying from this condition.

There were no differences in the risk of cough, headache, or elevated blood potassium.

Conclusion

ACE inhibitors, a group of medications to lower high blood pressure, reduce the risk of kidney disease and death in people with diabetes and normal kidney function.

Comparison of blood pressure–lowering medications with placebo