diabetes - angiotensin renin system blockade - all type of patients clinical trials results meta-analysis

<h1> <a href="index.html"> <strong>diabetes</strong> - angiotensin renin system blockade </a> - all type of patients trial results systematic overview and meta-analysis </h1> <h2>Main characteristics of the included studies</h2> <table> <tr> <th>Trial</th> <th>Treatments</th> <th>Patients</th> <th>Methods</th> </tr> <tr> <td> <a href="TRC_t598.html"> UKPDS 39, 1998 </a> <br> </td> <td> captopril 25 mg/d aiming at a BP <150/85<br>  <i>versus</i> <br> atenolol 50mg/d aiming at a BP <150/85 </td> <td> hypertensive patients with type 2 diabetes </td> <td> follow-up ND<br> n=400/358<br> Parallel groups<br> open <br> UK </td> </tr> <tr> <td> <a href="TRC_t599.html"> UKPDS 38, 1998 </a> <br> </td> <td> tight control of blood pressure aiming at a BP <150/85 (with the use of captopril or atenolol as main treatment, other treatment were added if the control criteria were not met) <br>  <i>versus</i> <br> less tight control aiming at a blood pressure of <180/105 (avoiding treatment with ACE inhibitors or beta-blockers) </td> <td> hypertensive patients with type 2 diabetes </td> <td> follow-up 8.4y (median)<br> n=758/390<br> Parallel groups<br> open <br> UK </td> </tr> <tr> <td> <a href="index.html"> ADVANCE, 2007 </a> <br> NCT00145925 </td> <td> fixed combination of perindopril and indapamide<br>  <i>versus</i> <br> placebo </td> <td> patients with type 2 diabetes irrespective of initial blood pressure levels or the use of other blood pressure lowering drugs </td> <td> follow-up <br> n=-9/-9<br> <br> <br> </td> </tr> <tr> <td> <a href="TRC_t7041.html"> HOPE (diabetic subgroup), 2000 </a> <br> </td> <td> ramipril 10 mg once per day orally<br>  <i>versus</i> <br> placebo </td> <td> patients with diabetes (sub group), aged 55 years or older, who had a previous cardiovascular event or at least one other cardiovascular risk factor, no clinical proteinuria, heart failure, or low ejection fraction </td> <td> follow-up 4.5 years<br> n=1808/1759<br> Factorial plan<br> double-blind <br> North, South america, Europe </td> </tr> <tr> <td> <a href="TRC_t7042.html"> RENAAL, 2001 </a> <br> </td> <td> losartan 50 to 100 mg once daily<br>  <i>versus</i> <br> placebo </td> <td> patients with type 2 diabetes and nephropathy </td> <td> follow-up 3.4 y<br> n=751/762<br> Parallel groups<br> double-blind <br> America, Europe, Asia </td> </tr> <tr> <td> <a href="TRC_t7043.html"> IPDM, 2001 </a> <br> </td> <td> irbesartan, at a dose of either 150 mg daily or 300 mg daily<br>  <i>versus</i> <br> placebo </td> <td> hypertensive patients with type 2 diabetes and microalbuminuria </td> <td> follow-up 2 years<br> n=389/201<br> Parallel groups<br> double-blind <br> Worldwide </td> </tr> <tr> <td> <a href="TRC_t7044.html"> CAPP (diabetic subgroup), 1999 </a> <br> </td> <td> Captopril initial dose of 50 mg daily given in one or two doses<br>  <i>versus</i> <br> thiazide diuretic or beta-blocker </td> <td> Patients aged 25-66 years with a measured diastolic blood pressure of 100 mm Hg or more on two occasions; subgroup of diabetic patients </td> <td> follow-up 6.1 year<br> n=309/263<br> Parallel groups<br> open with blinded assessment <br> Sweden, Finland </td> </tr> <tr> <td> <a href="TRC_t7048.html"> STOP-2 ACEI (diabetic subgroup), 2000 </a> <br> </td> <td> ACE inhibitor<br>  <i>versus</i> <br> conventional treatment (diuretic or beta-blocker) </td> <td> diabetic (subgroup) elderly patients aged 70-84 years with hypertension </td> <td> follow-up 5.03y<br> n=235/253<br> Parallel groups<br> open with blind assessment <br> Sweden </td> </tr> <tr> <td> <a href="TRC_t7049.html"> IDNT irbesartan, 2001 </a> <br> </td> <td> Irbesartan 300 mg daily <br>  <i>versus</i> <br> placebo </td> <td> hypertensive patients with nephropathy due to type 2 diabetes </td> <td> follow-up 2.6 years<br> n=579/569<br> Parallel groups<br> double blind <br> Worldwide </td> </tr> <tr> <td> <a href="TRC_t7051.html"> IDNT (irbesartan vs amlodipine), 2001 </a> <br> </td> <td> Irbesartan 300 mg daily <br>  <i>versus</i> <br> amlodipine 10 mg daily </td> <td> hypertensive patients with nephropathy due to type 2 diabetes </td> <td> follow-up 2.6 years<br> n=579/567<br> Parallel groups<br> double blind <br> Worldwide </td> </tr> <tr> <td> <a href="TRC_t10738.html"> LIFE (diabetic subgroup), 2002 </a> <br> </td> <td> losartan 50mg daily at step 1<br>  <i>versus</i> <br> atenolol 50mg daily at step 1 </td> <td> patients with diabetes (subgroup) , hypertension, and signs of left-ventricular hypertrophy on electrocardiograms </td> <td> follow-up 4.7 years<br> n=586/609<br> Parallel groups<br> double-blind <br> USA, UK, Nordic countries </td> </tr> <tr> <td> <a href="TRC_t10739.html"> ALLHAT (lisi vs chlor, diabetic subgroup), 2002 </a> <br> </td> <td> lisinopril 10 to 40 mg/d<br>  <i>versus</i> <br> chlorthalidone 12.5 to 25 mg/d </td> <td> diabetic (subgroup) participants aged 55 years or older with hypertension </td> <td> follow-up <br> n=3212/5528<br> Parallel groups<br> double-blind <br> </td> </tr> <tr> <td> <a href="TRC_t10741.html"> STOP-2 (ACEI vs CCB) (diabetic subgroup), 2000 </a> <br> </td> <td> ACE inhibitor <br>  <i>versus</i> <br> calcium antagonists </td> <td> diabetic (subgroup) elderly patients aged 70-84 years </td> <td> follow-up 5.03y<br> n=235/231<br> <br> open with blind assessment <br> Sweden </td> </tr> <tr> <td> <a href="index.html"> ROADMAP, 2010 </a> <br> NCT00185159 </td> <td> olmesartan at 40 mg/day<br>  <i>versus</i> <br> placebo </td> <td> patients with diabetes and at least one additional cardiovascular risk factor, but no evidence of renal dysfunction </td> <td> follow-up 3.2 y<br> n=2232/2215<br> Parallel groups<br> double-blind <br> Europe </td> </tr> <tr> <td> <a href="index.html"> ORIENT, </a> <br> NCT00141453 </td> <td> olmesartan<br>  <i>versus</i> <br> placebo </td> <td> patients with diabetic Nephropathy and overt proteinuria secondary to type 2 diabetes mellitus </td> <td> follow-up <br> n=282/284<br> Parallel groups<br> double-blind <br> Japan, Hong Kong </td> </tr> </table> <h2>References</h2> <p> <b>UKPDS 39, 1998 : </b> Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. <i>BMJ 1998;317:703-13</i> [PMID 9732337] </p> <p> <b>UKPDS 39, 1998 : </b> Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. <i>BMJ 1998;317:713-20</i> [PMID 9732338] </p> <p> <b>UKPDS 38, 1998 : </b> Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. <i>BMJ 1998;317:713-20</i> [PMID 9732338] </p> <p> <b>UKPDS 38, 1998 : </b> Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. <i>BMJ 1998;317:703-13</i> [PMID 9732337] </p> <p> <b>ADVANCE, 2007 : </b> Rationale and design of the ADVANCE study: a randomised trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus. Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation. <i>J Hypertens Suppl 2001 Nov;19:S21-8</i> [PMID 11848259] </p> <p> <b>ADVANCE, 2007 : </b> Patel A, MacMahon S, Chalmers J, Neal B, Woodward M, Billot L, Harrap S, Poulter N, Marre M, Cooper M, Glasziou P, Grobbee DE, Hamet P, Heller S, Liu LS, Mancia G, Mogensen CE, Pan CY, Rodgers A, Williams BEffects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. <i>Lancet 2007 Sep 8;370:829-40</i> [PMID 17765963] </p> <p> <b>HOPE (diabetic subgroup), 2000 : </b> Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. <i>Lancet 2000;355:253-9</i> [PMID 10675071] </p> <p> <b>HOPE (diabetic subgroup), 2000 : </b> Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais GEffects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. <i>N Engl J Med 2000;342:145-53</i> [PMID 10639539] </p> <p> <b>RENAAL, 2001 : </b> Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar SEffects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. <i>N Engl J Med 2001;345:861-9</i> [PMID 11565518] </p> <p> <b>IPDM, 2001 : </b> Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner PThe effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. <i>N Engl J Med 2001;345:870-8</i> [PMID 11565519] </p> <p> <b>CAPP (diabetic subgroup), 1999 : </b> Hansson L, Lindholm LH, Niskanen L, Lanke J, Hedner T, Niklason A, Luomanmäki K, Dahlöf B, de Faire U, Mörlin C, Karlberg BE, Wester PO, Björck JEEffect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. <i>Lancet 1999;353:611-6</i> [PMID 10030325] </p> <p> <b>STOP-2 ACEI (diabetic subgroup), 2000 : </b> Lindholm LH, Hansson L, Ekbom T, Dahlöf B, Lanke J, Linjer E, Scherstén B, Wester PO, Hedner T, de Faire UComparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group. <i>J Hypertens 2000;18:1671-5</i> [PMID 11081782] </p> <p> <b>STOP-2 ACEI (diabetic subgroup), 2000 : </b> Hansson L, Lindholm LH, Ekbom T, Dahlöf B, Lanke J, Scherstén B, Wester PO, Hedner T, de Faire URandomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. <i>Lancet 1999;354:1751-6</i> [PMID 10577635] </p> <p> <b>STOP-2 ACEI (diabetic subgroup), 2000 : </b> Hansson L, Hedner T, Dahlöf BProspective randomized open blinded end-point (PROBE) study. A novel design for intervention trials. Prospective Randomized Open Blinded End-Point. <i>Blood Press 1992;1:113-9</i> [PMID 1366259] </p> <p> <b>IDNT irbesartan, 2001 : </b> Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz IRenoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. <i>N Engl J Med 2001;345:851-60</i> [PMID 11565517] </p> <p> <b>IDNT (irbesartan vs amlodipine), 2001 : </b> Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz IRenoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. <i>N Engl J Med 2001;345:851-60</i> [PMID 11565517] </p> <p> <b>UKPDS 38 10 years, 2008 : </b> Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DRLong-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes. <i>N Engl J Med 2008;:</i> [PMID 18784091] </p> <p> <b>LIFE (diabetic subgroup), 2002 : </b> Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristiansson K, Lederballe-Pedersen O, Nieminen MS, Omvik P, Oparil S, Wedel H, Aurup P, Edelman J, Snapinn SCardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. <i>Lancet 2002;359:1004-10</i> [PMID 11937179] 10.1016/S0140-6736(02)08090-X </p> <p> <b>LIFE (diabetic subgroup), 2002 : </b> Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel HCardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. <i>Lancet 2002;359:995-1003</i> [PMID 11937178] 10.1016/S0140-6736(02)08089-3 </p> <p> <b>ALLHAT (lisi vs chlor, diabetic subgroup), 2002 : </b> Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). <i>JAMA 2002;288:2981-97</i> [PMID 12479763] </p> <p> <b>STOP-2 (ACEI vs CCB) (diabetic subgroup), 2000 : </b> Lindholm LH, Hansson L, Ekbom T, Dahlöf B, Lanke J, Linjer E, Scherstén B, Wester PO, Hedner T, de Faire UComparison of antihypertensive treatments in preventing cardiovascular events in elderly diabetic patients: results from the Swedish Trial in Old Patients with Hypertension-2. STOP Hypertension-2 Study Group. <i>J Hypertens 2000 Nov;18:1671-5</i> [PMID 11081782] </p> <p> <b>STOP-2 (ACEI vs CCB) (diabetic subgroup), 2000 : </b> Hansson L, Lindholm LH, Ekbom T, Dahlöf B, Lanke J, Scherstén B, Wester PO, Hedner T, de Faire URandomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. <i>Lancet 1999;354:1751-6</i> [PMID 10577635] </p> <p> <b>ROADMAP, 2010 : </b> Ritz E, Viberti GC, Ruilope LM, Rabelink AJ, Izzo JL Jr, Katayama S, Ito S, Mimran A, Menne J, Rump LC, Januszewicz A, Haller HDeterminants of urinary albumin excretion within the normal range in patients with type 2 diabetes: the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study. <i>Diabetologia 2010;53:49-57</i> [PMID 19876613] 10.1007/s00125-009-1577-3 </p> <p> <b>Mauer, 2009 : </b> Mauer M, Zinman B, Gardiner R, Suissa S, Sinaiko A, Strand T, Drummond K, Donnelly S, Goodyer P, Gubler MC, Klein RRenal and retinal effects of enalapril and losartan in type 1 diabetes. <i>N Engl J Med 2009;361:40-51</i> [PMID 19571282] 10.1056/NEJMoa0808400 </p> <p> <b>DIRECT 1-3, 2009 : </b> Bilous R, Chaturvedi N, Sjølie AK, Fuller J, Klein R, Orchard T, Porta M, Parving HHEffect of candesartan on microalbuminuria and albumin excretion rate in diabetes: three randomized trials. <i>Ann Intern Med 2009;151:11-20, W3-4</i> [PMID 19451554] </p>