Effect of Antihypertensive Therapy on the Kidney in Patients with Diabetes: A Meta-Regression Analysis

  1. Bertram L. Kasiske, MD;
  2. Roberto S. N. Kalil, MD;
  3. Jennie Z. Ma, MS;
  4. Minjen Liao, MD; and
  5. William F. Keane, MD
  1. From Hennepin County Medical Center, Minneapolis, Minnesota. Requests for Reprints: Bertram L. Kasiske, MD, Division of Nephrology, Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415. Acknowledgments: The authors thank Ms. Jan Lovick and Ms. Dee Lunzer for help in preparing the manuscript; and Thomas Louis, PhD, Chairman, Department of Biostatistics, University of Minnesota, for helpful suggestions and guidance.

    Abstract

    Objective: To assess the relative effect of different antihypertensive agents on proteinuria and renal function in patients with diabetes.

    Data Sources: We used MEDLINE and bibliographies in recent articles to identify studies of the effects of antihypertensive agents on renal function in patients with diabetes.

    Study Selection: We selected 100 controlled and uncontrolled studies that provided data on renal function, proteinuria, or both, before and after treatment with an antihypertensive agent.

    Data Extraction: Data on blood pressure, renal function, proteinuria, patient characteristics (for example, age, sex, and type of diabetes), and study design (for example, random allocation and the use of a placebo) were extracted from selected studies.

    Data Synthesis: Multiple linear regression analysis indicated that angiotensin-converting enzyme (ACE) inhibitors decreased proteinuria independent of changes in blood pressure, treatment duration, and the type of diabetes or stage of nephropathy, as well as study design (P < 0.0001). Reductions in proteinuria from other antihypertensive agents could be entirely explained by changes in blood pressure. Blood pressure reduction in itself was associated with a relative increase in glomerular filtration rate (regression coefficient [±SE], 3.70 ±.92 mL/min for each reduction of 10 mm Hg in mean arterial pressure; P = 0.0002); however, compared with other agents, ACE inhibitors had an additional favorable effect on glomerular filtration rate that was independent of blood pressure changes (3.41 ± 1.71 mL/min; P = 0.05).

    Conclusion: Angiotensin-converting enzyme inhibitors can decrease proteinuria and preserve glomerular filtration rate in patients with diabetes. These effects occur independent of changes in systemic blood pressure.

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    1. Ann Intern Med January 15, 1993 vol. 118 no. 2 129-138
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