Study investigates antihypertensives in patients with diabetes and kidney disease

The comparative efficacy and safety of antihypertensive drugs in adults with diabetes and kidney disease is unclear. To investigate, an international team performed a network meta-analysis of 157 randomised controlled trials with 43,256 participants, including some previously unpublished data.

All studies had at least eight weeks of follow-up and evaluated orally administered blood pressure-lowering drugs.

No blood pressure-lowering strategy prolonged survival in adults with diabetes and kidney disease. However, dual therapy with an angiotensin-receptor blocker (ARB) and an angiotensin converting enzyme inhibitor (ACEi) and ARB monotherapy were each effective for the prevention of end-stage kidney disease, with odds ratios of 0.62 (95% confidence interval [CI] 0.43–0.90) and 0.77 (95% CI 0.65–0.92), respectively, compared with placebo.

Combined ARB/ACEi therapy was ranked lowest for hyperkalaemia and acute kidney injury among all regimens evaluated in the study, published in The Lancet^[1] (2015;385:2047–2056).