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Do agents that block the RAS truly offer renoprotective effects in early stage, nonproteinuric nephropathy?

Radica Alicic1, Katherine R Tuttle

  • 1Providence Medical Research Center, University of Washington School of Medicine, PO Box 2555, 101 West 8th Avenue, Spokane, WA 99220-2555, USA. alicicr@intmedspokane.org

Current Hypertension Reports
|January 8, 2008
PubMed

Insights

Renin-angiotensin system (RAS) antagonists are not as crucial as blood pressure control for early kidney disease prevention. Achieving target blood pressure often requires multiple antihypertensive agents.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Clinical guidelines recommend renin-angiotensin system (RAS) antagonists for hypertension in diabetes and chronic kidney disease.
  • These recommendations often cite potential blood pressure (BP)-independent renoprotective effects.
  • The relevance for early-stage, nonproteinuric nephropathy requires further evaluation.

Purpose of the Study:

  • To assess the importance of RAS antagonists versus BP control in preventing kidney disease progression.
  • To review primary and secondary prevention studies for early-stage nephropathy.

Main Methods:

  • Systematic review of primary prevention studies in diabetic populations.
  • Systematic review of secondary prevention studies including hypertensive/normotensive, diabetic/nondiabetic patients with microalbuminuria or low glomerular filtration rate.

Main Results:

  • Blood pressure (BP) control appears more critical than the use of RAS antagonists as a first-line agent.
  • Achieving optimal BP levels frequently necessitates the use of multiple antihypertensive medications.
  • Evidence for BP-independent benefits of RAS antagonists in early nephropathy is limited.

Conclusions:

  • The primary importance lies in achieving target blood pressure levels for kidney protection.
  • Further long-term studies are needed to determine if specific agents offer benefits beyond BP control in early-stage, nonproteinuric nephropathy.

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