Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial
| Autor: | Daniela Leonardis, Mirella Alpa, Carmine Zoccali, Ivan Nediyalkov Chakarski, Carlo Basile, Elena Perticucci, Giovanni Garini, Adalberto Sessa, Gianbattista Sorba, Marta Turturro, Piero Ruggenenti, Giacomina Loriga, Giuseppe Remuzzi, Maria Lesti, Bogdan Ene-Iordache, Maria Ganeva, Renzo Scanziani, Annalisa Perna |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Ramipril medicine.medical_specialty Adolescent Urology Angiotensin-Converting Enzyme Inhibitors Blood Pressure Nephropathy law.invention Randomized controlled trial law Diabetes mellitus Humans Medicine Antihypertensive Agents Aged Felodipine business.industry Hazard ratio General Medicine Middle Aged Calcium Channel Blockers medicine.disease Surgery Proteinuria Blood pressure ACE inhibitor Disease Progression Kidney Failure Chronic Drug Therapy Combination Female Kidney Diseases business Glomerular Filtration Rate Kidney disease medicine.drug |
| Zdroj: | The Lancet. 365:939-946 |
| ISSN: | 0140-6736 |
| Popis: | 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.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 (diastolic90 mm Hg; n=169) or intensified (systolic/diastolic130/80 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.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).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. |
| Databáze: | OpenAIRE |
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