PMID: 22552566May 4, 2012Paper

Critically appraised article

Revista médica de Chile
Ignacio Neumann, Bruno Grassi

Abstract

Angiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors are known to reduce proteinuria. Their combination might be more effective than either treatment alone, but long-term data for comparative changes in renal function are not available. We investigated the renal effects of ramipril (an ACE inhibitor), telmisartan (an ARB), and their combination in patients aged 55 years or older with established atherosclerotic vascular disease or with diabetes with end-organ damage. The trial ran from 2001 to 2007. After a 3-week run-in period, 25,620 participants were randomly assigned to ramipril 10 mg a day (n = 8,576), telmisartan 80 mg a day (n = 8,542), or to a combination of both drugs (n = 8,502; median follow-up was 56 months), and renal function and proteinuria were measured. The primary renal outcome was a composite of dialysis, doubling of serum creatinine, and death. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00153101. 784 patients permanently discontinued randomised therapy during the trial because of hypotensive symptoms (406 on combination therapy, 149 on ramipril, and 229 on telmisartan). The number of events for the composite primary outcom...Continue Reading

References

Oct 30, 1998·JAMA : the Journal of the American Medical Association·D L Sackett, S E Straus
Nov 4, 2011·The Journal of Investigative Dermatology·Hywel C Williams, Robert P Dellavalle
Apr 7, 2012·Academic Radiology·Gelareh SadighPaul Cronin

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