Effectiveness of Renin-Angiotensin System Inhibition in Normotensive Diabetic Patients With Microalbuminuria: A Systematic Review and Meta-Analysis
Author(s)
GOUDICHERLA MANASA, Masters in Pharmacy Practice.
Research Scholar, NATIONAL INSTITUTE OF PHARMACEUTICAL EDUCATION & RESEARCH, Medak, India.
Research Scholar, NATIONAL INSTITUTE OF PHARMACEUTICAL EDUCATION & RESEARCH, Medak, India.
OBJECTIVES: To investigate the impact of treatment duration on long-term renal outcomes and to systematically assess the efficacy of angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEIs) in lowering microalbuminuria, maintaining renal function, and halting the development of to macro-albuminuria in normotensive patients with type 1 and type 2 diabetes.
METHODS: The present review was registered in PROSPERO with ID (CRD42024571295). Asystematic literature search was conducted in PubMed, Embase, Rayyan, Cochrane, Scopus, and clinicaltrials.gov. The search focused on randomized controlled trials involving normotensive type 1 or 2 diabetes patients with micro-albuminuria, comparing ACE inhibitors (ACE) or angiotensin receptor blockers(ARBs) to placebo. The primary outcome was the reduction in microalbuminuria and secondary outcome was changes in eGFR. Pooled weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
RESULTS: A total of 15 RCTs including 1374 patients. Ten RCTs used ACEIs and five used ARBs. ACE/ARBs showed significant reduction of micro-albuminuria in T1DM (-64.78 % [-81.56, -47.99]; I2=73%, P 0.001) and T2DM (-60.09 % [-80.93, -39.25]; I2=92%, P <0.0001) patients. A duration-based analysis showed greater reductions with longer treatment (>3 years: −117.6%). A 75% risk reduction (Micro to macro-albuminuria) was noticed with RAS inhibition (OR: 0.25; 95% CI: 0.13 to 0.49; I2=0%, P 0.99) compared to placebo.
CONCLUSIONS: RAS inhibition with ACEIs/ARBs may significantly reduce microalbuminuria and preserve renal function in normotensive diabetic patients. These findings suggest a potential role beyond blood pressure control, warranting further investigation in long-term outcome trials
METHODS: The present review was registered in PROSPERO with ID (CRD42024571295). Asystematic literature search was conducted in PubMed, Embase, Rayyan, Cochrane, Scopus, and clinicaltrials.gov. The search focused on randomized controlled trials involving normotensive type 1 or 2 diabetes patients with micro-albuminuria, comparing ACE inhibitors (ACE) or angiotensin receptor blockers(ARBs) to placebo. The primary outcome was the reduction in microalbuminuria and secondary outcome was changes in eGFR. Pooled weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
RESULTS: A total of 15 RCTs including 1374 patients. Ten RCTs used ACEIs and five used ARBs. ACE/ARBs showed significant reduction of micro-albuminuria in T1DM (-64.78 % [-81.56, -47.99]; I2=73%, P 0.001) and T2DM (-60.09 % [-80.93, -39.25]; I2=92%, P <0.0001) patients. A duration-based analysis showed greater reductions with longer treatment (>3 years: −117.6%). A 75% risk reduction (Micro to macro-albuminuria) was noticed with RAS inhibition (OR: 0.25; 95% CI: 0.13 to 0.49; I2=0%, P 0.99) compared to placebo.
CONCLUSIONS: RAS inhibition with ACEIs/ARBs may significantly reduce microalbuminuria and preserve renal function in normotensive diabetic patients. These findings suggest a potential role beyond blood pressure control, warranting further investigation in long-term outcome trials
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO87
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy, Relating Intermediate to Long-term Outcomes
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas, Urinary/Kidney Disorders