ACE Inhibitors and ARB Blockers, Alone or in Combination, Appear to Be Most Effective Drug Regimen for Preventing End-Stage Renal Disease

Blood-pressure-lowering drugs do not improve life expectancy among adults with diabetes and kidney disease, according to a new study of the global evidence published in the May 23, 2015 issue of The Lancet. The article is titled “Comparative Efficacy and Safety of Blood Pressure-Lowering Agents in Adults with Diabetes and Kidney Disease: A Network Meta-Analysis.” However, the study, which brings together 157 studies involving more than 43,000 adults with diabetes, shows that angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blocker (ARB) treatments, alone or in combination, are the most effective drug regimen for preventing end-stage kidney disease -- an important finding given that diabetes is now the leading cause of people starting dialysis. This finding is important because until now it has not been known whether any available treatment can protect kidney function in the long term, and combination therapy of an ACEi and an ARB has been thought to cause harm. While treatments in the new study have been shown to help patients, the study also shows that any benefits of treatment need to be balanced against potential side-effects. In fact, the study provides a unique opportunity for busy clinicians, who simply cannot read all the literature, to review existing evidence which has been analyzed using the highly innovative technology of network meta-analysis. This measures specifically both the benefits and harms of all available treatments and provides a ranking of the most effective interventions.
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