FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3141578732> ?p ?o ?g. }

• W3141578732 endingPage "899" @default.
• W3141578732 startingPage "898" @default.
• W3141578732 abstract "We have some comments to make on the meta-analysis by Juan Casas and colleagues.1Casas JP Chua W Loukogeorgakis S et al.Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis.Lancet. 2005; 366: 2026-2033Summary Full Text Full Text PDF PubMed Scopus (623) Google Scholar Large randomised trials are regarded as the gold standard in assessing the efficacy of clinical interventions.2LeLorier J Gregoire G Benhaddad A Lapierre J Derderian F Discrepancies between meta-analyses and subsequent large randomized, controlled trials.N Engl J Med. 1997; 337: 536-542Crossref PubMed Scopus (1008) Google Scholar 2001 saw the publication of three such trials that dealt with prevention and treatment of diabetic nephropathy by blocking the renin-angiotensin system in patients with type 2 diabetes.3Brenner BM Cooper ME de Zeeuw D et al.Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N Engl J Med. 2001; 345: 861-869Crossref PubMed Scopus (6273) Google Scholar, 4Lewis EJ Hunsicker LG Clarke WR et al.Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.N Engl J Med. 2001; 345: 851-860Crossref PubMed Scopus (5134) Google Scholar, 5Parving H-H Lehnert H Bröchner-Mortensen J Gomis R Andersen S Arner P The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.N Engl J Med. 2001; 345: 870-878Crossref PubMed Scopus (2971) Google Scholar All three showed renoprotective effects above and beyond the beneficial effect of lowering systemic blood pressure. Standard statistical methods were applied to adjust for the small recorded differences in blood pressure. On the basis of these findings, the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products approved losartan and irbesartan for renoprotection in patients with type 2 diabetes. Guidelines in Europe and the USA were developed recommending angiotensin-receptor blockers as first-line treatment for the prevention of diabetic nephropathy and end-stage renal disease. In their meta-analysis, Casas and colleagues conclude: “The benefits of ACE inhibitors or ARBs on renal outcomes in placebo-controlled trials probably result from a blood-pressure-lowering effect. In patients with diabetes, additional renoprotective action of these substances beyond lowering blood pressure remains unproven”. Most studies included in the meta-analysis were published before 2002, with one exception: the ALLHAT study. Since ALLHAT had a dominating effect on the meta-analysis, it should be assessed carefully and critically. The study dealt with high-risk hypertensive patients including 12 063 with type 2 diabetes. Urinary excretion of protein or albumin was not measured, precluding correct classification of renal disease. The renal outcomes were based on a post-hoc analysis. The cause of end-stage renal disease and any precipitating clinical circumstances, such as acute renal failure, were not assessed. In other words, numerous renal and non-renal disorders including drug-related nephrotoxicity could have resulted in end-stage renal disease, by contrast with RENAAL3Brenner BM Cooper ME de Zeeuw D et al.Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N Engl J Med. 2001; 345: 861-869Crossref PubMed Scopus (6273) Google Scholar and IDNT.4Lewis EJ Hunsicker LG Clarke WR et al.Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.N Engl J Med. 2001; 345: 851-860Crossref PubMed Scopus (5134) Google Scholar Furthermore, the starting treatment in ALLHAT was 10 mg of lisinopril daily, which is not regarded as optimum for renoprotection; how many patients remained on that dose is not stated. We have shown that ultrahigh dosing of irbesartan (900 mg once daily) offers additional renoprotection independent of changes in 24-h systemic blood pressure.5Parving H-H Lehnert H Bröchner-Mortensen J Gomis R Andersen S Arner P The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.N Engl J Med. 2001; 345: 870-878Crossref PubMed Scopus (2971) Google Scholar We have several other concerns about the meta-analysis: first, the definition of end-stage renal disease does not include peritoneal dialysis; second, the relative risks in figure 2 differ from a rough and ready calculation based on the numbers shown; and third, at least three Scandinavian diabetic nephropathy studies are not included in figure 2 A despite data on end-stage renal disease being presented therein. We suggest that the conclusion of Casas and colleagues' meta-analysis should be interpreted with caution due to the heterogeneous patient groups, inconsistencies in reporting valid trial results, potentially suboptimal doses of ACE inhibitors and ARBs, and use of an endpoint that might have been improperly assessed. H-HP has equity in Novo Nordisk and Merck, and has received consulting and lecture fees from Merck, Bristol-Myers Squibb, Pfizer, and Sanofi, and grants from Merck and Bristol-Myers Squibb. Renoprotective effects of renin-angiotensin-system inhibitors – Authors' replyThe results of ALLHAT challenged widely held beliefs about the renoprotective effect of renin-angiotensin-system (RAS) inhibition and so it is unsurprising that each of the correspondents raises this as an issue. However, it is the largest randomised double-blind trial with the longest follow-up of the effects of antihypertensive drugs on renal outcomes and it fulfilled our prespecified inclusion criteria. Exclusion of ALLHAT from our analysis would, quite rightly, have prompted great criticism since the trial provides around half the available evidence on renal outcomes. Full-Text PDF" @default.
• W3141578732 created "2021-04-13" @default.
• W3141578732 creator A5044496367 @default.
• W3141578732 creator A5085592050 @default.
• W3141578732 date "2006-03-01" @default.
• W3141578732 modified "2023-10-16" @default.
• W3141578732 title "Renoprotective effects of renin-angiotensin-system inhibitors" @default.
• W3141578732 cites W2044773944 @default.
• W3141578732 cites W2056976690 @default.
• W3141578732 cites W2059911502 @default.
• W3141578732 cites W2328451703 @default.
• W3141578732 cites W3021250193 @default.
• W3141578732 doi "https://doi.org/10.1016/s0140-6736(06)68373-6" @default.
• W3141578732 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/16546532" @default.
• W3141578732 hasPublicationYear "2006" @default.
• W3141578732 type Work @default.
• W3141578732 sameAs 3141578732 @default.
• W3141578732 citedByCount "4" @default.
• W3141578732 crossrefType "journal-article" @default.
• W3141578732 hasAuthorship W3141578732A5044496367 @default.
• W3141578732 hasAuthorship W3141578732A5085592050 @default.
• W3141578732 hasBestOaLocation W31415787321 @default.
• W3141578732 hasConcept C126322002 @default.
• W3141578732 hasConcept C134018914 @default.
• W3141578732 hasConcept C168563851 @default.
• W3141578732 hasConcept C2777180221 @default.
• W3141578732 hasConcept C2779922275 @default.
• W3141578732 hasConcept C2780259554 @default.
• W3141578732 hasConcept C2780288358 @default.
• W3141578732 hasConcept C2781184683 @default.
• W3141578732 hasConcept C2908929049 @default.
• W3141578732 hasConcept C535046627 @default.
• W3141578732 hasConcept C555293320 @default.
• W3141578732 hasConcept C71924100 @default.
• W3141578732 hasConcept C84393581 @default.
• W3141578732 hasConcept C95190672 @default.
• W3141578732 hasConceptScore W3141578732C126322002 @default.
• W3141578732 hasConceptScore W3141578732C134018914 @default.
• W3141578732 hasConceptScore W3141578732C168563851 @default.
• W3141578732 hasConceptScore W3141578732C2777180221 @default.
• W3141578732 hasConceptScore W3141578732C2779922275 @default.
• W3141578732 hasConceptScore W3141578732C2780259554 @default.
• W3141578732 hasConceptScore W3141578732C2780288358 @default.
• W3141578732 hasConceptScore W3141578732C2781184683 @default.
• W3141578732 hasConceptScore W3141578732C2908929049 @default.
• W3141578732 hasConceptScore W3141578732C535046627 @default.
• W3141578732 hasConceptScore W3141578732C555293320 @default.
• W3141578732 hasConceptScore W3141578732C71924100 @default.
• W3141578732 hasConceptScore W3141578732C84393581 @default.
• W3141578732 hasConceptScore W3141578732C95190672 @default.
• W3141578732 hasFunder F4320307115 @default.
• W3141578732 hasFunder F4320307765 @default.
• W3141578732 hasFunder F4320307776 @default.
• W3141578732 hasIssue "9514" @default.
• W3141578732 hasLocation W31415787321 @default.
• W3141578732 hasLocation W31415787322 @default.
• W3141578732 hasOpenAccess W3141578732 @default.
• W3141578732 hasPrimaryLocation W31415787321 @default.
• W3141578732 hasRelatedWork W1563850031 @default.
• W3141578732 hasRelatedWork W1979341153 @default.
• W3141578732 hasRelatedWork W2038657938 @default.
• W3141578732 hasRelatedWork W2040299750 @default.
• W3141578732 hasRelatedWork W2040551893 @default.
• W3141578732 hasRelatedWork W2084478060 @default.
• W3141578732 hasRelatedWork W2126468069 @default.
• W3141578732 hasRelatedWork W2147036854 @default.
• W3141578732 hasRelatedWork W2345941387 @default.
• W3141578732 hasRelatedWork W3160586918 @default.
• W3141578732 hasVolume "367" @default.
• W3141578732 isParatext "false" @default.
• W3141578732 isRetracted "false" @default.
• W3141578732 magId "3141578732" @default.
• W3141578732 workType "article" @default.