Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
Department of Cardiac Surgery, Tianjin Chest Hospital, China.
Horm Metab Res. 2020 May;52(5):289-297. doi: 10.1055/a-1138-0959. Epub 2020 Mar 27.
The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing the progression of albuminuria and risk of cardiovascular events in hypertensive patients with diabetic kidney disease (DKD) is well-documented. However, the efficacy and safety of these agents in normotensive patients with DKD are still controversial. MEDLINE, Embase, and Cochrane Library were searched for relevant random controlled trials. The odd risk (OR) reductions were calculated with a random-effects model. Decrease in albuminuria, changes in eGFR, major cardiovascular events, and drug-related adverse events were analyzed. Thirteen RCTs including 1282 patients were retrieved. Compared with placebo or other active agent groups, ACEIs or ARBs significantly decreased albuminuria (MD -80.28 mg/d, 95% CI -104.79 mg/d to -55.77 mg/d), and the efficacy is independent of changes in blood pressure and systolic blood pressure at baseline. The result of subanalysis showed the declining of albuminuria was more significantly in normotensive DKD patients with 2DM (p=0.005). No significant differences were found with regard to the declining of evaluated glomerular filtration rate (eGFR) (MD -0.29 ml/min/1.73 m, 95% CI -2.99 to 2.41 ml/min/1.73 m). There were no significant differences in the side effect of the drugs such as hypotension and hyperkalemia. This meta-analysis demonstrated that ACEIs or ARBs can decrease albuminuria to varying degree in normotensive patients with DKD, and better response occurred in patients with 2DM.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）在降低合并糖尿病肾病（DKD）的高血压患者蛋白尿进展和心血管事件风险方面的作用已得到充分证实。然而，这些药物在血压正常的 DKD 患者中的疗效和安全性仍存在争议。我们检索了 MEDLINE、Embase 和 Cochrane Library 中的相关随机对照试验。采用随机效应模型计算优势比（OR）降低值。分析了蛋白尿减少、eGFR 变化、主要心血管事件和与药物相关的不良事件。共检索到 13 项 RCT，纳入 1282 名患者。与安慰剂或其他活性药物组相比，ACEI 或 ARB 可显著降低蛋白尿（MD-80.28mg/d，95%CI-104.79mg/d 至-55.77mg/d），其疗效与基线时血压和收缩压的变化无关。亚组分析结果表明，在合并 2 型糖尿病的血压正常的 DKD 患者中，蛋白尿的下降更为显著（p=0.005）。在评估肾小球滤过率（eGFR）的下降方面，差异无统计学意义（MD-0.29ml/min/1.73m，95%CI-2.99 至 2.41ml/min/1.73m）。药物的副作用如低血压和高钾血症等方面也没有显著差异。本荟萃分析表明，ACEI 或 ARB 可不同程度地降低血压正常的 DKD 患者的蛋白尿，在合并 2 型糖尿病的患者中反应更好。
