TABLE 1.
Effects of angiotensin receptor blockers on the development of cardiovascular disease in pre-dialysis or on-dialysis patients with CKD.
| Class of RAAS blocker | Authors, Year; Reference number | Patients | Study design | Study protocol | Results |
|---|---|---|---|---|---|
| ARB | Tobe et al., 2011; 24 | N = 1480; eGFR <60 (mL/min/1.73 m2) Serum creatinine concentration <3.0 mg/dL | RCT; Multicenter double-blind placebo-controlled clinical trial | Telmisartan 80 mg or placebo once daily; 4–7 years | No improvement in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure was found with telmisartan therapy compared with placebo in patients with CKD (p value was not shown). |
| Imai et al., 2011; 10 | N = 577; Serum creatinine concentration was 1.2–2.5 mg/dL in men and 1.0–2.5 mg/dL in women | RCT; Double-blind placebo-controlled clinical trial; Secondary outcomes | Olmesartan 10–40 mg once daily or placebo; 4 years | No improvement in cardiovascular outcomes, including cardiovascular death, non-fatal stroke except for transient ischemic attack, nonfatal myocardial infarction, hospitalization for unstable angina, hospitalization for heart failure, revascularization of coronary was found with olmesartan therapy compared with placebo in patients with CKD (HR, 0.73; 95% CI, 0.48 to 1.09; p = 0.126). | |
| Kim-Mitsuyama et al., 2018; 13 | N = 187; eGFR <45 (mL/min/1.73 m2) | RCT; Multicenter open-label placebo-controlled clinical trial; Secondary outcomes | Olmesartan 20–80 mg once daily or placebo; 3 years | In patients with advanced CKD, olmesartan-based therapy may confer greater benefit in prevention of cardiovascular events than placebo therapy (HR, 0.465; 95% CI, 0.224 to 0.965; p = 0.040). | |
| Cice et al., 2010; 4 | N = 332; Hemodialysis; Chronic heart failure with reduced ejection fraction <40% within 6 months | RCT; Multicenter double-blind placebo-controlled clinical trial | Telmisartan 80 mg or placebo per day; 3 years | Telmisartan significantly reduced cardiovascular death (HR,0.42; 95% CI, 0.38 to 0.61; p < 0.0001), and hospital admission of chronic heart failure (HR, 0.38; 95% CI, 0.19 to 0.51; p < 0.0001) in 3 years in patients on maintenance hemodialysis compared with placebo. |
ARB, angiotensin receptor blocker; CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HR, hazard ratio; RAAS, renin–angiotensin–aldosterone system; RCT, randomized controlled trial