[Antihypertensive agents for the prevention of chronic kidney disease progression: guideline from the Italian Society of Nephrology].
BACKGROUND
The current 3rd edition of the Italian Society of Nephrology guidelines has been drawn up to summarize evidence of key intervention issues on the basis of systematic reviews (SR) of randomized trials (RCT) or RCT data only. In the present guideline, evidence of the use of antihypertensive agents to prevent chronic kidney disease progression (CKD) is presented.


METHODS
SR of RCT and RCT on antihypertensive agents used to prevent CKD progression were identified referring to a Cochrane Library and Renal Health Library search (2005 update).


RESULTS
Seven SR and 26 further RCT were found addressing this intervention issue. Methodological quality of available RCT was suboptimal according to current methodological standards. Angiotensin converting enzyme inhibitors (ACE-I) are associated with significant effects on the prevention of CKD progression in non-diabetic and diabetic patients (evidence from SR). Angiotensin receptor blockers (ARB) are as effective as ACE-I in delaying CKD progression in diabetic and non-diabetic patients (evidence from SR). Dihydropyridine and non-dihydropyridine calcium antagonists have not been found to significantly affect proteinuria and CKD progression (evidence from SR). Combination therapy with ACE-I and ARB is associated with a significant reduction in the risk of CKD progression and proteinuria, but long term data are only available in patients with non-diabetic nephropathy (evidence from RCT).


CONCLUSIONS
Available evidence of renal protection suggest that ACE-I and ARB should be recommended in CKD patients (diabetic and non-diabetic nephropathy). Further studies are necessary to test the effectiveness of other antihypertensive agents or combination therapy.
Del Vecchio
L
L
Italian Society of Nephrology - Italy.
Manno
C
C
Ravani
P
P
De Nicola
L
L
Cianciaruso
B
B
D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents