02 Nov Diabetes: Renoprotective Effects of ACE Inhibitors
MedicalResearch.com Interview with:
Hon-Yen Wu, Lecturer
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
MedicalResearch.com: What are the main findings of the study?
Answer: We used the Bayesian network meta-analysis to evaluate the efficacy of different antihypertensive treatment strategies on survival and major renal outcomes for diabetic patients. We found that angiotensin converting enzyme (ACE) inhibitor therapy is the only treatment that significantly prevents the doubling of serum creatinine levels compared with placebo. Our analysis also shows the significant inferiority of β blockers in all cause mortality. The available evidence is not able to show a significant difference between angiotensin receptor blockers (ARBs) and ACE inhibitors. Although the protective effect of ACE inhibitor plus calcium channel blocker compared with placebo was not statistically significant, yet this combination therapy showed the greatest probability of being the best treatment option in reducing mortality.
MedicalResearch.com: Were any of the findings unexpected?
A number of included studies showed low event rates or even no events in one or both treatment arms, and those studies increase the uncertainty in the comparisons of multiple treatments within a network meta-analysis, giving rise to wide credible intervals for several treatment comparisons with low event rates.
MedicalResearch.com: What should clinicians and patients take away from your report?
Our study shows the renoprotective effects of ACE inhibitors for diabetic patients. As the available evidence does not show a better protective effect of ARBs compared with ACE inhibitors, our findings support the use of ACE inhibitors to reduce the cost. Calcium channel blockers in combination with ACE inhibitors may be an alternative, if adequate blood pressure control cannot be achieved by the use of ACE inhibitors alone.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Some patient characteristics and methodological quality, such as age, sex, cardiovascular diseases, as well as selection bias or performance bias, might be potential confounders for our analyses. However, metaregression or subgroup analysis in network meta-analysis is very complex and its statistical power is relatively low. Whether those potential confounders have substantial influences on treatment outcomes in patients with diabetes deserves further studies in the future.
Wu H ,Huang J ,Lin H ,Liao W ,Peng Y ,Hung K ,et al. Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis. BMJ 2013;347:f6008