Cargando…

Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)

Combination therapy with angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors (ACEIs) requires further evaluation in patients with diabetic nephropathy and hypertension. In a post hoc analysis of the Olmesartan Reducing Incidence of Endstage renal disease in diabetic Nephrop...

Descripción completa

Detalles Bibliográficos
Autores principales: Imai, Enyu, Haneda, Masakazu, Yamasaki, Tetsu, Kobayashi, Fumiaki, Harada, Atsushi, Ito, Sadayoshi, Chan, Juliana CN, Makino, Hirofumi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853587/
https://www.ncbi.nlm.nih.gov/pubmed/24026038
http://dx.doi.org/10.1038/hr.2013.86
_version_ 1782294653571170304
author Imai, Enyu
Haneda, Masakazu
Yamasaki, Tetsu
Kobayashi, Fumiaki
Harada, Atsushi
Ito, Sadayoshi
Chan, Juliana CN
Makino, Hirofumi
author_facet Imai, Enyu
Haneda, Masakazu
Yamasaki, Tetsu
Kobayashi, Fumiaki
Harada, Atsushi
Ito, Sadayoshi
Chan, Juliana CN
Makino, Hirofumi
author_sort Imai, Enyu
collection PubMed
description Combination therapy with angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors (ACEIs) requires further evaluation in patients with diabetic nephropathy and hypertension. In a post hoc analysis of the Olmesartan Reducing Incidence of Endstage renal disease in diabetic Nephropathy Trial with hypertension, we examined the effects of olmesartan on renal and cardiovascular outcomes in the presence or absence of an ACEI. Among 563 patients randomized to receive either olmesartan (n=280) or placebo (n=283), 73.5% (n=414) received a concomitant ACEI. Compared with placebo, olmesartan significantly reduced proteinuria in both the ACEI-treated and non-ACEI-treated groups. The respective changes in the urinary protein creatinine ratio in the olmesartan-treated and placebo-treated groups were −32.6% and +21.1% without an ACEI (P=0.001) and −17.0% and +2.2% with an ACEI (P=0.028). In the olmesartan group, 115 patients developed primary renal outcomes (41.1%) compared with 129 (45.6%) in the placebo group (hazard ratio (HR): 0.97, P=0.787). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 1.02 (P=0.891) and 0.84 (P=0.450). 40 olmesartan-treated patients (14.3%) and 53 placebo-treated patients (18.7%) developed secondary cardiovascular outcomes (HR: 0.65, P=0.042). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 0.69 (P=0.129) and 0.51 (P=0.129). Olmesartan was well tolerated. Dual blockade treatment caused more hyperkalemia than monotherapy. In patients with diabetic nephropathy and hypertension, olmesartan significantly reduced proteinuria, independent of ACEI treatment and cardiovascular outcome but failed to show additional renal benefit compared with ACEI treatment alone. The cardiovascular benefit of dual treatment requires further evaluation.
format Online
Article
Text
id pubmed-3853587
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Nature Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-38535872013-12-06 Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension) Imai, Enyu Haneda, Masakazu Yamasaki, Tetsu Kobayashi, Fumiaki Harada, Atsushi Ito, Sadayoshi Chan, Juliana CN Makino, Hirofumi Hypertens Res Original Article Combination therapy with angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors (ACEIs) requires further evaluation in patients with diabetic nephropathy and hypertension. In a post hoc analysis of the Olmesartan Reducing Incidence of Endstage renal disease in diabetic Nephropathy Trial with hypertension, we examined the effects of olmesartan on renal and cardiovascular outcomes in the presence or absence of an ACEI. Among 563 patients randomized to receive either olmesartan (n=280) or placebo (n=283), 73.5% (n=414) received a concomitant ACEI. Compared with placebo, olmesartan significantly reduced proteinuria in both the ACEI-treated and non-ACEI-treated groups. The respective changes in the urinary protein creatinine ratio in the olmesartan-treated and placebo-treated groups were −32.6% and +21.1% without an ACEI (P=0.001) and −17.0% and +2.2% with an ACEI (P=0.028). In the olmesartan group, 115 patients developed primary renal outcomes (41.1%) compared with 129 (45.6%) in the placebo group (hazard ratio (HR): 0.97, P=0.787). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 1.02 (P=0.891) and 0.84 (P=0.450). 40 olmesartan-treated patients (14.3%) and 53 placebo-treated patients (18.7%) developed secondary cardiovascular outcomes (HR: 0.65, P=0.042). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 0.69 (P=0.129) and 0.51 (P=0.129). Olmesartan was well tolerated. Dual blockade treatment caused more hyperkalemia than monotherapy. In patients with diabetic nephropathy and hypertension, olmesartan significantly reduced proteinuria, independent of ACEI treatment and cardiovascular outcome but failed to show additional renal benefit compared with ACEI treatment alone. The cardiovascular benefit of dual treatment requires further evaluation. Nature Publishing Group 2013-12 2013-09-12 /pmc/articles/PMC3853587/ /pubmed/24026038 http://dx.doi.org/10.1038/hr.2013.86 Text en Copyright © 2013 The Japanese Society of Hypertension http://creativecommons.org/licenses/by-nc-sa/3.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
spellingShingle Original Article
Imai, Enyu
Haneda, Masakazu
Yamasaki, Tetsu
Kobayashi, Fumiaki
Harada, Atsushi
Ito, Sadayoshi
Chan, Juliana CN
Makino, Hirofumi
Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title_full Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title_fullStr Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title_full_unstemmed Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title_short Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)
title_sort effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the orient: a post-hoc analysis (orient–hypertension)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853587/
https://www.ncbi.nlm.nih.gov/pubmed/24026038
http://dx.doi.org/10.1038/hr.2013.86
work_keys_str_mv AT imaienyu effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT hanedamasakazu effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT yamasakitetsu effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT kobayashifumiaki effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT haradaatsushi effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT itosadayoshi effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT chanjulianacn effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension
AT makinohirofumi effectsofdualblockadeofthereninangiotensinsystemonrenalandcardiovascularoutcomesintype2diabeteswithovertnephropathyandhypertensionintheorientaposthocanalysisorienthypertension