ARB treatment of high CV risk patients
Clinical Question
In patients with heart disease or advanced diabetes, does the use of angiotensin-receptor blocker treatment prevent the development of renal failure?
Bottom Line
Treatment with telmisartan -- and, by extrapolation, other angiotensin-receptor blockers -- does not prevent the development of chronic renal disease in patients with cardiovascular disease or with diabetes and other end-organ damage. Yes, it decreases the development of albuminuria, but that is not a useful predictor of subsequent renal failure, at least in this patient population. (LOE = 1b)
Reference
Mann JF, Schmieder RE, Dyal L, et al, for the TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) Investigators. Effect of telmisartan on renal outcomes. A randomized trial. Ann Intern Med 2009;151(1):1-10. [PMID:19451556]
Study Design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
Concealed
Setting
Outpatient (any)
Synopsis
The researchers conducting this study enrolled 5926 patients with documented cardiovascular disease or diabetes with end-organ damage who could not tolerate angiotensin-converting enzyme inhibitor treatment. The patients received either placebo or telmisartan 80 mg per day for an average 4.75 years (allocation was concealed). Blood pressure was aggressively controlled in both groups, though patients receiving telmisartan had significantly lower blood pressure, on average. Approximately 10 percent of the patients had microalbuminuria and 1.4% had macroalbuminuria. Intention-to-treat analysis was not used; only patients completing the study were included in the analysis, which may not be of concern since fewer than 0.5% of the patients were lost to follow-up. After an average of almost 5 years, the incidence of albuminuria -- both micro and macro -- was lower in the telmisartan-treated group, though the incidence of the composite outcome of dialysis or doubling of serum creatinine was not different between the 2 groups (1.96% vs 1.55%; P = .2). One caveat: although the study was large, the number of events -- dialysis or creatinine doubling -- was small, and the study may not have been powerful enough to find a difference if one truly exists.
Citation
Barry, Henry, et al., editors. "ARB Treatment of High CV Risk Patients." EE+ POEM Archive, John Wiley & Sons, 2024. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426850/all/ARB_treatment_of_high_CV_risk_patients.
ARB treatment of high CV risk patients. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2024. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426850/all/ARB_treatment_of_high_CV_risk_patients. Accessed November 7, 2024.
ARB treatment of high CV risk patients. (2024). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426850/all/ARB_treatment_of_high_CV_risk_patients
ARB Treatment of High CV Risk Patients [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2024. [cited 2024 November 07]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426850/all/ARB_treatment_of_high_CV_risk_patients.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - ARB treatment of high CV risk patients
ID - 426850
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426850/all/ARB_treatment_of_high_CV_risk_patients
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -