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Antihypertensive, antiproteinuric therapy and myocardial infarction and stroke prevention

Kenneth L Choi1, William J Elliott

  • 1Department of Preventive Medicine, RUSH Medical College, 1700 West Van Buren Street, Suite 470, Chicago, IL 60612, USA.

Current Hypertension Reports
|September 15, 2005
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) benefit kidney health by reducing proteinuria. However, these drugs do not independently lower cardiovascular risks like heart attack or stroke.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Proteinuria indicates kidney damage and predicts cardiovascular events.
  • Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) reduce proteinuria and slow kidney disease progression, independent of blood pressure.
  • Large trials like IDNT and RENAAL studied ARBs in type 2 diabetic patients with proteinuria.

Purpose of the Study:

  • To evaluate the cardiovascular effects of ACEIs and ARBs beyond their blood pressure-lowering capabilities.
  • To determine if ARBs offer independent protection against myocardial infarction and stroke in diabetic nephropathy.

Main Methods:

  • Analysis of data from large, randomized, prospective trials (IDNT, RENAAL).
  • Comparison of ARBs versus placebo in type 2 diabetic patients with proteinuria.
  • Review of broader clinical trial data comparing ACEIs and ARBs with other antihypertensives.

Main Results:

  • Neither the Irbesartan Diabetic Nephropathy Trial (IDNT) nor the Reduction in Endpoints in NIDDM with the Angiotensin Antagonist Losartan (RENAAL) study showed a reduction in myocardial infarction or stroke incidence with ARBs compared to placebo.
  • A comprehensive review of clinical trials did not reveal significant blood pressure-independent cardiovascular benefits (stroke, myocardial infarction) for ACEIs or ARBs.

Conclusions:

  • While ACEIs and ARBs are effective in reducing proteinuria and slowing renal impairment, they do not appear to offer independent cardiovascular protection against myocardial infarction or stroke.
  • For cardiovascular outcomes, achieving blood pressure reduction is likely more critical than the specific mechanism initiated by ACEIs or ARBs.

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