Clinical trials in nephrology: success or failure.
OBJECTIVE
A large amount of clinical and epidemiologic evidence has been gathered supporting the importance of blood pressure control in reducing chronic kidney disease progression. Suppression of the rennin-angiotensin-aldosterone system should also be considered in any patient with chronic kidney disease, in particular if albuminuria is present.


RESULTS
Analysis of renal outcome by estimating glomerular filtration rate in trials primarily devoted to cardiovascular protection in hypertensive patients, in particular the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial trial, has come to question the effectiveness of suppressing the rennin-angiotensin-aldosterone system in controlling blood pressure and thus protecting the kidney in hypertensive patients. This subject is particularly interesting because the existence of an increased cardiovascular risk associated with renal function decline has been demonstrated in many different clinical conditions including arterial hypertension. The increase in global cardiovascular risk accompanying chronic kidney disease would necessitate the use of drugs suppressing the rennin-angiotensin-aldosterone system for cardiovascular protection irrespective of the influence on renal outcome.


CONCLUSIONS
This review includes the most recent data evaluating renal endpoints in clinical trials primarily devoted to renal function as well as those dedicated to arterial hypertension and its cardiovascular consequences.
Garcia-Donaire
Jose A
JA
Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain.
Segura
Julian
J
Ruilope
Luis M
LM
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents