An International Research Team, led by the University of Valencia, the Incliva Health Research Institute and the Biomedical Research Center in Mental Health Network (CIBERSAM), publishes a work that compares the effects at the cardiovascular and renal level ofThree types of antihypertensive medications, used in patients with diabetes.
The antihypertensives analyzed are the inhibitors of the enzyme converter of angiotensin (IECA), the antagonists of the angiotensin II (ARA II) receptor, and the direct inhibitor of the renin, used in adult patients with diabetes.The study reinforces the recommendations of the main European and North American clinical practice guides that recommend the use of IECA and Ara II as an antihypertensive treatment.
The article, whose first author is Ferrán Catalá-López, a researcher at the University of Valencia and Incliva and where Rafael Tabarés-Seisdedos, Professor of Psychiatry and principal researcher at Cibersam also participates, points as conclusions that there are no significant differences between the effects ofThe different antihypertensive treatments evaluated.
"Although we have not found differences in the effects of these treatments on cardiovascular and renal prevention, the IECA and the ARA II do present different treatment costs that have to be considered in clinical practice," according to Catalá-López.
Using an innovative analysis technique, known as network meta-analysis (Network MetA-Analysis, in English), researchers used the combined data of 71 random and unpublished random clinical trials, in which a total of 103,120 diabetic people participated.
On them they tested the effects of different medications or combinations of both, which act inhibiting the renin-angiotensin system, a hormonal system that helps to regulate the blood pressure and the volume of body cells in the long term.
The study reinforces the recommendations recommended by the use of IECA and ARA II drugs as an antihypertensive treatment
Specifically, scientists have not found significant differences in the reduction of cardiovascular risk between the IECA and the ARA II, either in monotherapy or in combination.Similarly, for the risk of renal disease progression, no significant differences have been detected between the IECAs and any of the remaining therapies, such as ARA II or a combination of IECA jointly with the ARA II.
They have also deduced that no strategy that inhibits the renin-angiotensin system was superior to the IECA with respect to general mortality, cardiovascular mortality, heart infarction, cerebral infarction, renal disease in the terminal stage, or in duplicating serum creatinine values.
Costs and benefits
Arterial hypertension (or high blood pressure) can damage the heart, blood vessels and kidneys and cause cardiovascular and renal diseases.It is estimated that approximately two thirds of the adult population have high blood pressure or take medications to reduce it.Because diabetes increases the risk of cardiovascular and renal diseases, controlling blood pressure is key in the management of these patients.
The fact that the combination of two drugs has not had better results than with a single IECA or ARA II - together with the results of other studies in which an increase in adverse effects was observed in patients who took the combination of IECA and ARAII– It would advise the use of the combination of inhibitors of the Renin-Angiotensin system, the investigation stands out.
The work also contradicts previous studies that suggest that ARA II could increase the risk of developing diseasesCardiovascular in patients with diabetes.The study also points out that there are not enough data that evaluate the effects of the direct inhibitor of the Renin, Aliskiren, with the IECA or Ara II to establish conclusions on the role of this medicine in relation to other antihypertensives most used and known, andTherefore, more additional research could be justified.
In addition, the researchers stand out in the conclusion that the costs of any medicine have not been taken into account, or any side effect that was not relevant to the measured clinical results.In this sense, the authors explain: "Clinicians should discuss the balance between costs, benefits and potential damage to patients before starting treatment with these therapies."
BIBLIOGRAPHIC REFERENCE:
Cardiovascular and Renal Outcomes of Renin-Chartensin System Blockade in Adult Patients With Diabetes Mellitus: A Systematic Review With Network Metwork Metwork. Link
Published in collaboration with researchers from the Spanish Agency for Medicines and Health Products and the Research Institute of the Ottawa Hospital (Canada).
