Journal ArticleDOI
Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy
Linda F. Fried,Nicholas V. Emanuele,Nicholas V. Emanuele,Jane H. Zhang,Mary Brophy,Todd A. Conner,William C. Duckworth,William C. Duckworth,David J. Leehey,David J. Leehey,Peter A. McCullough,Theresa Z. O'Connor,Paul M. Palevsky,Robert F. Reilly,Stephen L. Seliger,Stuart R. Warren,Suzanne Watnick,Peter Peduzzi,Peter Peduzzi,Peter Guarino +19 more
TLDR
Combination therapy with an ACE inhibitor and an ARB was associated with an increased risk of adverse events among patients with diabetic nephropathy and safety outcomes included mortality, hyperkalemia, and acute kidney injury.Abstract:
Background Combination therapy with angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) decreases proteinuria; however, its safety and effect on the progression of kidney disease are uncertain. Methods We provided losartan (at a dose of 100 mg per day) to patients with type 2 diabetes, a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 300, and an estimated glomerular filtration rate (GFR) of 30.0 to 89.9 ml per minute per 1.73 m 2 of body-surface area and then randomly assigned them to receive lisinopril (at a dose of 10 to 40 mg per day) or placebo. The primary end point was the first occurrence of a change in the estimated GFR (a decline of ≥30 ml per minute per 1.73 m 2 if the initial estimated GFR was ≥60 ml per minute per 1.73 m 2 or a decline of ≥50% if the initial estimated GFR was <60 ml per minute per 1.73 m 2 ), end-stage renal disease (ESRD), or death. The secondary renal end point was the first occurrence of a decline in the estimated GFR or ESRD. Safety outcomes included mortality, hyperkalemia, and acute kidney injury. Results The study was stopped early owing to safety concerns. Among 1448 randomly assigned patients with a median follow-up of 2.2 years, there were 152 primary endpoint events in the monotherapy group and 132 in the combination-therapy group (hazard ratio with combination therapy, 0.88; 95% confidence interval [CI], 0.70 to 1.12; P = 0.30). A trend toward a benefit from combination therapy with respect to the secondary end point (hazard ratio, 0.78; 95% CI, 0.58 to 1.05; P = 0.10) decreased with time (P = 0.02 for nonproportionality). There was no benefit with respect to mortality (hazard ratio for death, 1.04; 95% CI, 0.73 to 1.49; P = 0.75) or cardiovascular events. Combination therapy increased the risk of hyperkalemia (6.3 events per 100 person-years, vs. 2.6 events per 100 person-years with monotherapy; P<0.001) and acute kidney injury (12.2 vs. 6.7 events per 100 person-years, P<0.001). Conclusions Combination therapy with an ACE inhibitor and an ARB was associated with an increased risk of adverse events among patients with diabetic nephropathy. (Funded by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development; VA NEPHRON-D ClinicalTrials.gov number, NCT00555217.)read more
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2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more
Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: Since 1980, the American College of Cardiology and American Heart Association have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health.
Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: The next generation of scientists and decision-makers will have a greater understanding of what constitutes a credible threat to public health and how to protect them from that threat.
Journal ArticleDOI
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.
Juhani Knuuti,William Wijns,Antti Saraste,Davide Capodanno,Emanuele Barbato,Christian Funck-Brentano,Eva Prescott,Robert F. Storey,Christi Deaton,Thomas Cuisset,Stefan Agewall,Kenneth Dickstein,Thor Edvardsen,Javier Escaned,Bernard J. Gersh,Pavel Svitil,Martine Gilard,David Hasdai,Robert Hatala,Felix Mahfoud,Josep Masip,Claudio Muneretto,Marco Valgimigli,Stephan Achenbach,Jeroen J. Bax +24 more
TL;DR: In this article, the authors present guidelines for the management of patients with coronary artery disease (CAD), which is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries.
Journal ArticleDOI
2018 ESC/ESH Guidelines for the management of arterial hypertension : The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension
Bryan Williams,Giuseppe Mancia,Wilko Spiering,Enrico Agabiti Rosei,Michel Azizi,Michel Burnier,Denis Clement,Antonio Coca,Giovanni de Simone,Anna F. Dominiczak,Thomas Kahan,Felix Mahfoud,Josep Redon,Luis M. Ruilope,Alberto Zanchetti,Mary Kerins,Sverre E. Kjeldsen,Reinhold Kreutz,Stéphane Laurent,Gregory Y.H. Lip,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,Roland E. Schmieder,Evgeny Shlyakhto,Costas Tsioufis,Victor Aboyans,Ileana Desormais +27 more
TL;DR: De Backer et al. as mentioned in this paper developed the ESC Guidelines for the ESC Review Co-ordinator, which are used for the evaluation of the ESC review process and the review process.
References
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K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification
Andrew S. Levey,Josef Coresh,Kline Bolton,Bruce Culleton,Kathy Schiro Harvey,T. Alp Ikizler,Cynda Ann Johnson,Annamaria T. Kausz,Paul L. Kimmel,John W. Kusek,Adeera Levin,Kenneth L. Minaker,Robert Nelson,Helmut G. Rennke,Michael Steffes,Beth Witten,Ronald J. Hogg,Susan Furth,Kevin V. Lemley,Ronald J. Portman,George Schwartz,Joseph Lau,Ethan M Balk,Ronald D. Perrone,Tauqeer Karim,Lara Rayan,Inas Al-Massry,Priscilla Chew,Brad C. Astor,Deirdre De Vine,Garabed Eknoyan,Nathan W. Levin,Sally Burrows-Hudson,William F. Keane,Alan S. Kliger,Derrick Latos,Donna Mapes,Edith Oberley,Kerry Willis,George R. Bailie,Gavin J. Becker,Jerrilynn Burrowes,David Churchill,Allan J. Collins,William Couser,Dick DeZeeuw,Alan Garber,Thomas Golper,Frank A. Gotch,Antonio M. Gotto,Joel W. Greer,Richard H. Grimm,Ramon G. Hannah,Jaime Herrera Acosta,Ronald J. Hogg,Lawrence G. Hunsicker,Michael J. Klag,Saulo Klahr,Caya Lewis,Edmund G. Lowrie,Arthur J. Matas,Sally McCulloch,Maureen Michael,Joseph V. Nally,John M. Newmann,Allen R. Nissenson,Keith Norris,William F. Owen,Thakor G. Patel,Glenda Payne,Rosa A. Rivera-Mizzoni,David A. Smith,Robert A. Star,Theodore Steinman,Fernando Valderrábano,John Walls,Jean Pierre Wauters,Nanette Wenger,Josephine P. Briggs +78 more
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Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy
Barry M. Brenner,Mark E. Cooper,Dick de Zeeuw,William F. Keane,William E. Mitch,Hans-Henrik Parving,Giuseppe Remuzzi,Steven M. Snapinn,Zhonxin Zhang,Shahnaz Shahinfar +9 more
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Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes
Edmond J Lewis,Lawrence G. Hunsicker,William R. Clarke,Tomas Berl,Marc A. Pohl,Julia B. Lewis,Eberhard Ritz,Robert C. Atkins,Richard D. Rohde,Itamar Raz +9 more
TL;DR: The angiotensin-II-receptor blocker irbesartan is effective in protecting against the progression of nephropathy due to type 2 diabetes, independent of the reduction in blood pressure it causes.
Journal ArticleDOI
The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The collaborative study group
TL;DR: Captopril protects against deterioration in renal function in insulin-dependent diabetic nephropathy and is significantly more effective than blood-pressure control alone.
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The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy.
TL;DR: Whether captopril has kidney-protecting properties independent of its effect on blood pressure in diabetic nephropathy is determined.
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