Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial.
By P. Ruggenenti, A. Perna, G. Loriga, M. Ganeva, Bogdan Ene-Iordache, Marta Turturro, M. Lesti, E. Perticucci, I. Chakarski, D. Leonardis and 8 more. The Lancet, 2005
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BACKGROUND In chronic nephropathies, inhibition of angiotensin-converting enzyme (ACE) is renoprotective, but can further renoprotection be achieved by reduction of blood pressure to lower than usual targets? We aimed to assess the effect of intensified versus conventional blood-pressure control on progression to end-stage renal disease. METHODS We undertook a multicentre, randomised controlled trial of patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril (2.5-5 mg/day). We randomly assigned participants either conventional (diastolic <90 mm Hg; n=169) or intensified (systolic/diastolic <130/80 mm Hg; n=169) blood-pressure control. To achieve the intensified blood-pressure level, patients received add-on therapy with the dihydropyridine calcium-channel blocker felodipine (5-10 mg/day). The primary outcome measure was time to end-stage renal disease over 36 months' follow-up, and analysis was by intention to treat. FINDINGS Of 338 patients who were randomised, three (two assigned intensified and one allocated conventional blood-pressure control) never took study drugs and they were excluded. Over a median follow-up of 19 months (IQR 12-35), 38/167 (23%) patients assigned to intensified blood-pressure control and 34/168 (20%) allocated conventional control progressed to end-stage renal disease (hazard ratio 1.00 [95% CI 0.61-1.64]; p=0.99). INTERPRETATION In patients with non-diabetic proteinuric nephropathies receiving background ACE-inhibitor therapy, no additional benefit from further blood-pressure reduction by felodipine could be shown.
Subfields: Cardiology and Cardiovascular Medicine, Nephrology
View Paper: https://www.semanticscholar.org/paper/dbaf98fbaca83a27810effa2a3b137cf6f0c4c90
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In Cardiology and Cardiovascular Medicine
Citations in the corpus
- Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. (2016, background): “Among the 15 trials, five (n = 6,960) enrolled only patients with diabetes [16,23,25,26,31] and six specifically recruited participants with CKD (n = 2,734) (Table 1) [22,29,30,33–35].”
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2018, unknown): “, 2005 (171) 15766995 Aim: To determine whether intensive BP control will achieve further renoprotection (delayed progression to ESRD) compared to standard BP control in pts with chronic nephropathies”