ACE, ARB or Both for pateints with proteinuria

Progression from proteinuria to CKD can be prevented by giving ACE inhibitors and we know ARB also effective. This meta analysis compares effects of ACE inhibitors and ARB on proteinuria and also looks at efficacy and clinical safety of combining these two drugs. This meta anlysis is published in Annals of Internal Medicine.

The final pool of available trials included 49 trials involving a total of 6181 patients. The agents used in the studies are summarized below:

* 12 studies compared ARBs with placebo;

* 9 studies compared ARBs with calcium channel blockers;

* 23 studies compared ARBs with ACE inhibitors; and

* 16 studies compared ARBs with combinations of ARB plus ACE inhibitor.

Conclusion from this study is combination of an ACEI and an ARB may be
considered for individual patients, particularly for those who are not receiving significant benefit from monotherapy targeting proteinuria and who are at a low risk for possible adverse events.