Table 5.
Examples of renoprotective effects in selected randomized controlled trials* of angiotensin II receptor blockers.
| Agent | Type 2 diabetes
|
Other populations
|
||
|---|---|---|---|---|
| Study | Key findings | Study | Key findings | |
| Losartan | RENAAL | Significant reductions in SCr doubling and ESRD in mostly hypertensive pts with T2D and nephropathy39 | ROAD | Significant reductions in SCr doubling and ESRD when dosing losartan based on antiproteinuric effects in nondiabetic proteinuric chronic renal disease, with reductions similar to those with antiproteinuric benazepril dosing41 |
| AMADEO | Significantly less effective in reducing proteinuria vs. telmisartan in hypertensive pts with T2D and nephropathy116 | JLIGHT | Significant reduction in proteinuria vs. amlodipine in pts with proteinuric chronic renal disease and hypertension (diabetic nephropathy allowed but population was mainly chronic glomerulonephritis)40 | |
|
| ||||
| Valsartan | MARVAL | Significant reduction in microalbuminuria vs. amlodipine in normotensive or hypertensive pts with T2D and microalbuminuria57 | MARVAL-2 | Significant reduction in albuminuria with valsartan/HCTZ vs. amlodipine/HCTZ in hypertensive pts with albuminuria42 |
| SMART | Significant reduction in microalbuminuria vs. amlodipine in Japanese hypertensive pts with T2D and microalbuminuria58 | VALERIA | Significant reduction in albuminuria and increase in rate of microalbuminuria normalization for valsartan/lisinopril vs. lisinopril alone in hypertensive pts with microalbuminuria59 | |
| VIVALDI | Similar antiproteinuric effect vs. telmisartan in hypertensive pts with T2D and nephropathy117 | HKVIN | Significant reduction in proteinuria and slowing of GFR reduction vs. placebo in pts with IgA nephropathy60 | |
|
| ||||
| Candesartan | CENTRO | Significant reduction in albuminuria vs. enalapril in hypertensive pts with T2D61 | ||
| DIRECT (3 studies) | No prevention of microalbuminuria vs. placebo in mostly normotensive pts with T1D or T2D76 | |||
|
| ||||
| Irbesartan | IDNT | Significant reductions in SCr doubling and ESRD vs. amlodipine and placebo in hypertensive pts with T2D and microalbuminuria86 | IMPROVE | No significant reduction in microalbuminuria for irbesartan/ramipril vs. placebo/ramipril in hypertensive pts with microalbuminuria and increased CV risk88 |
| IRMA-2 | Significant reduction in nephropathy vs. placebo in hypertensive pts with T2D and microalbuminuria87 | |||
|
| ||||
| Telmisartan | DETAIL | Similar renoprotection vs. enalapril in hypertensive pts with T2D and early nephropathy99 | ONTARGET | Similar reduction in dialysis or SCr doubling and similar effects on albuminuria vs. ramipril in pts at high vascular risk, with a detrimental effect of combination treatment on dialysis/SCr doubling and in the primary composite (which included death)98 |
| VIVALDI | Similar antiproteinuric effect vs. valsartan in hypertensive pts with T2D and nephropathy117 | TRANSCEND | No significant improvement in composite of dialysis or SCr doubling vs. placebo in ACEI-intolerant pts with high vascular risk (CV disease or diabetes with EOD) but no macroalbuminuria, with a significant reduction in albuminuria but significantly greater GFR reduction with telmisartan97 | |
| INNOVATION | Significant reduction in conversion from incipient to overt nephropathy vs. placebo in normotensive or hypertensive pts with T2D96 | |||
| AMADEO | Significant reduction in proteinuria vs. losartan in hypertensive pts with T2D and nephropathy116 | |||
*
In which the overall study population included >100 patients.
ACEI=angiotensin-converting enzyme inhibitor; CV=cardiovascular; EOD=end-organ damage; ESRD=end-stage renal disease; GFR=glomerular filtration rate; HCTZ=hydrochlorothiazide; IgA=immunoglobulin A; pts=patients; SCr=serum creatinine; T1D=type 1 diabetes; T2D=type 2 diabetes.