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Assessment and Communication for People with Disorders of Consciousness
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Published on: August 1, 2017

[Critically appraised article].

Ignacio Neumann1, Bruno Grassi

  • 1Unidad de Medicina Basada en Evidencia, Escuela de Medicina, Pontificia Universidad Católica de Chile. ignacio.neumann@gmail.com

Revista Medica De Chile
|May 4, 2012
PubMed
Summary
This summary is machine-generated.

In high-risk patients, telmisartan and ramipril showed similar renal outcomes. Combination therapy reduced proteinuria but worsened major renal outcomes, despite similar efficacy to monotherapy.

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Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Angiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors are established treatments for reducing proteinuria.
  • Long-term comparative renal function data for combined ARB and ACE inhibitor therapy are limited.
  • This study evaluated the renal effects of ramipril (ACE inhibitor), telmisartan (ARB), and their combination in older adults with vascular disease or diabetes with end-organ damage.

Purpose of the Study:

  • To compare the long-term renal effects of ramipril monotherapy, telmisartan monotherapy, and combination therapy in high-risk patients.
  • To assess the impact of these treatments on major renal outcomes, including dialysis, serum creatinine doubling, and death.
  • To evaluate changes in estimated glomerular filtration rate (eGFR) and proteinuria.

Main Methods:

  • A large-scale, randomized trial involving 25,620 participants aged 55 years or older.
  • Participants were assigned to ramipril 10 mg/day, telmisartan 80 mg/day, or a combination of both drugs.
  • Median follow-up was 56 months, with renal function and proteinuria as primary and secondary outcomes.

Main Results:

  • Major renal outcomes were similar for telmisartan and ramipril monotherapy but increased with combination therapy (14.5% vs. 13.5%, HR 1.09, p=0.037).
  • Combination therapy led to a higher incidence of dialysis or doubling of serum creatinine (2.49% vs. 2.03-2.21%, HR 1.24, p=0.038).
  • Ramipril showed the least decline in eGFR, while combination therapy resulted in the greatest decline; combination therapy and telmisartan reduced proteinuria more than ramipril.

Conclusions:

  • Telmisartan demonstrates comparable effects on major renal outcomes to ramipril in patients at high vascular risk.
  • While combination therapy significantly reduces proteinuria, it is associated with worse major renal outcomes compared to monotherapy.
  • The findings suggest caution when using combined ACE inhibitor and ARB therapy for renal protection in this population.