A team of international research, led by Universitat de València, INCLIVA Health Research Institute and CIBERSAM Centre for Biomedical Research in Mental Health Network, has published this Tuesday in the prestigious magazine ‘PLoS Medicine’ a work that compares cardiovascular and kidney effects of three kind of antihypertensive medication, used in patient with diabetes.
The study reinforces the recommendations of the main guides of European and American clinical practice which recommend the use of ACE inhibitors and ARBs as antihypertensive treatment.
Antihypertensive medications analysed are the angiotensin-converting-enzyme inhibitor (ACE inhibitor), Angiotensin II receptor antagonists (ARBs), and direct renin inhibitors, used with adults patients with diabetes. The article, whose first author is Ferrán Catalá-López, researcher of the Universitat de València and INCLIVA and where participated the full university professor of Psychiatry and main researcher of CIBERSAM Rafael Tabarés-Seisdedos, points to conclusions that there are not significant differences between the effects in different antihypertensive treatments evaluated. ‘Despite we did not find differences in the effects of these treatments to prevent cardiovascular and kidney problems, ACE inhibitors and ARBs present different treatment costs that must be considered in clinical practical’, said Catalá-López.
By using a innovative analysis technique, known as network meta-analysis, the researchers used combined data of 71 randomly clinical trials, published o not, where a total of 130,120 diabetic people participated. On them, they tested different medications or both combination, which act by inhibiting the renin–angiotensin system, a hormonal system which helps to regulate in the long run the blood pressure and the volume of body cells.
Specifically, researchers have not found significant differences in the reduction or cardiovascular risk between ACE inhibitors and ARBs, whether in monotherapy or in combination. The same way, to the risk of progression of kidney disease, they have not detected significant differences between the ACE inhibitors and whatever remaining therapies, like ARBs or a combination of ACE inhibitors with ARBs. Moreover, they have deduced that not one strategy that inhibits the renin–angiotensin system was greater than ACE inhibitors regarding general mortality, cardiovascular mortality, heart attacks, cerebral infarct, kidney disease in terminal stage, or in duplicate the values of serum creatinine.
Chronic hypertension (or high blood pressure) can damage the heart, blood vessels and kidneys, and it can cause cardiovascular and kidney diseases. It is estimated that approximately two thirds of the adult population has high blood pressure or takes medications to reduce it. Due to the fact that diabetes increases the risk of cardiovascular and kidney diseases, to control blood pressure is a key in the management of these patients.
The work ‘Cardiovascular and Renal Outcomes of Renin–Angiotensin System Blockade in Adult Patients with Diabetes Mellitus: A Systematic Review with Network Meta-Analyses’ has been published in collaboration with researchers of the Agencia Española de Medicamentos y Productos Sanitarios (Spanish Agency of Medicine and Health Products) and the Ottawa Hospital Research Institute (Canada). It reinforces the recommendations of the main guides of European and American clinical practice which recommend the use of ACE inhibitors and ARBs as antihypertensive treatment in patients with diabetes.
The fact that the treatment with a combination of both medicines had not had better results than with an only ACE inhibitors or ARBs- with the results of other studies where was observed an increase of adverse effects in patients which took the combination of ACE inhibitors and ARBs- advises against the use of the combination of renin–angiotensin system, highlights the research.
The work, published by ‘PLoS Medicine’ contradicts previous studies that suggested that ARBs could increase the risk of developing cardiovascular diseases in patients with diabetes. The work points to that there are not enough data that value the effects of the direct renin inhibitors aliskiren, with the Ace inhibitors or ARBs to establish conclusions about the role of this medication in relation to others antihypertensive more used and known, and therefore, it could be justified a greater additional research.
Furthermore, researchers highlight in the conclusion that they have not considered the cost of any medicament in detail, or any secondary effect that is not relevant to clinic results tested. This way, the author of the scientific article explain : ‘Clinics should discuss the balance between cost, benefits and possible damages with the patients before the treatment with these therapies starts’.
Evaluation of health technologies
Ferrán Catalá López is clinical epidemiologist with training in public health, preventive medicine and health economy. Currently, he is researcher senior research of the Universitat de València through the programme PROMETEO, of the INCLIVA and of the CIBERSAM of the Carlos III Health Institute. Moreover, he is affiliate investigator of the programme of clinical epidemiology of the Ottawa Hospital Research Institute (Canada). He is interested in the evaluation of health technologies, and in the fact that these contribute to transfer the knowledge from the clinical research to healthcare.
Last update: 9 de march de 2016 07:00.
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