Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: a randomized double-blind trial

Ruilope, Luis; Bruña, Ricardo; Rodríguez‐Pérez, José Carlos; Vinuesa, Soledad García de; Garrido, José; Romero, R.; Jarillo, D.; Raij, Leopoldo; Alvarez-Cantalapiedra, I.; Mercado, Ma R. Lázaro de; Campderá, F. Gómez; Ibañez, Dominique; Martín, F. García; Mora-Maciá, José; Nieto, J.; Vozmediano, Carmen; Hortal, L; Plaza, C; Aljama, Pedro; Gómez-Carrasco, J. M.; Soriano, Sagrario; Pérez-García, Ana; Garcés, Ledy Paola Armírola; Segura, Julián; Bonet, Josep; Vigil-Medina, A.; Gallar, Paloma; Oliet, Aniana; Bernis, Carmen; Sanz-Guajardo, D

doi:10.1097/00004872-200204000-00032

Cited by 44 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The literature search for the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure (BP) in CKD [8] identified 3 RCTs with a total of 330 participants comparing beta blockers vs RASi [28,29,30] and 5 RCTs with a total of 2,992 participants comparing CCBs vs RASi [31,32,33,34]. Our update search conducted in October 2021 found 1 additional RCT with 269 participants comparing non-RASi vs ramipril (35).…”

Section: Evidence Summarymentioning

confidence: 99%

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian context using the GRADE-ADOLOPMENT methodology

Alhasan¹,

Yepes-Núñez²,

Askandarani³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: This practice guideline was developed by the Chronic Kidney Disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its Health Holding Company commissioned this guideline project to support the realization of the Vision 2030's healthcare transformation pillar. Methods: The guideline synthesis was guided by the GRADE-ADOLOPMENT methodology. Results: The final adoloped guideline addressed 12 clinical questions on blood pressure management in patients with CKD through a set of recommendations and performance measures. The recommendations included antihypertensive agents in children, non-renin angiotensin system inhibition (Non-RASi) vs RASi in adults, intensive vs standard blood pressure targets, early vs late assessment for kidney replacement therapy (KRT), late vs early preparation strategy for KRT, CKD symptoms during assessment for KRT or conservative management, initiation of KRT in patients with deteriorating CKD, choice of KRT modality or conservative management in certain CKD patient groups, changing or discontinuing KRT modalities, review frequency for KRT or conservative management, and Information, education and support. Conclusions: These conditional recommendations were based on low to very low certainty of evidence that highlights the need for high-quality randomized trials comparing different antihypertensive agents in patients with CKD.

show abstract

Section: Evidence Summarymentioning

confidence: 99%

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian context using the GRADE-ADOLOPMENT methodology

Alhasan¹,

Yepes-Núñez²,

Askandarani³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Renin–angiotensin–aldosterone system blockade and renal protection: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers?

Ruilope

2005

Acta Diabetol

View full text Add to dashboard Cite

Renal function is closely associated with cardiovascular risk, to the extent that even minor renal abnormalities, which are present in 10% of the general population, carry a greatly elevated risk of cardiovascular disease, target-organ damage and death. Reducing blood pressure by 20 mmHg or more in patients with severe hypertension (>160/100 mmHg) and advanced renal disease is sufficient to ensure a considerable reduction in proteinuria. In patients with less severe disease, however, blockade of the renin-angiotensin-aldosterone system (RAAS) is necessary to restore normal renal function. Clinical studies have shown that angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which both overcome the activity of angiotensin II, provide renoprotection in diabetics and non-diabetic populations. Which class of drugs is more effective remains a subject of debate, but the evidence favours ARBs for providing more effective renoprotection in patients at risk of diabetic nephropathy. The ARBs preserve renal haemodynamics and reduce progression to end-stage renal disease by around 25% in patients with overt nephropathy and prevent progression to overt disease by up to 70% in patients with mild renal impairment. The combination of ARBs and ACE inhibitors is even more protective, halving the number of patients with progression of renal impairment compared with either monotherapy. Long-term clinical studies now under way will help to establish the relative efficacies of the ARBs and ACE inhibitors and provide greater insight into the benefits of combination therapy.

show abstract

Lessons from trials in hypertensive type 2 diabetic patients

Ruilope

2003

Current Science Inc

View full text Add to dashboard Cite

There is incontrovertible evidence that association of type 2 diabetes with hypertension markedly increases the risk of cardiovascular events, death, and nephropathy. In type 2 diabetes, even blood pressure values usually considered below the threshold for hypertension (ie, 140/90 mm Hg) in nondiabetic subjects represent an additional risk of clinical relevance. Evidence that more intensive blood pressure lowering is beneficial in type 2 diabetes over less intensive lowering is also overwhelming. However, most published trials show the need for combination therapy in the great majority of patients, and even with combination therapy it is difficult to attain the expected goal blood pressure, in particular goal systolic blood pressure. It should be recognized that the systolic blood pressure goal of less than 130 mm Hg is a very difficult one to achieve in diabetics. Evidence of the superiority or inferiority of different drug classes is vague and contradictory. Recent evidence concerning angiotensin II receptor antagonists has shown a significant reduction of cardiovascular events, cardiovascular death, and total mortality when losartan was compared with atenolol, but not when irbesartan was compared with amlodipine. If renal endpoints are considered, evidence of the benefit of angiotensin II receptor antagonists in type 2 diabetes is more robust than that available with angiotensin-converting enzyme inhibitors. Primary prevention of development of microalbuminuria seems to be greatly facilitated by strict blood pressure control. However, by attaining normal blood pressure levels (< 130/80 mm Hg), better preservation of glomerular filtration rate does not seem to be insured.

show abstract

Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: a randomized double-blind trial

Cited by 44 publications

References 18 publications

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian context using the GRADE-ADOLOPMENT methodology

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian context using the GRADE-ADOLOPMENT methodology

Renin–angiotensin–aldosterone system blockade and renal protection: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers?

Lessons from trials in hypertensive type 2 diabetic patients

Contact Info

Product

Resources

About