title: Antihypertensive treatments in adult autosomal dominant polycystic kidney disease: network meta-analysis of the randomized controlled trials.
abstract: BACKGROUND
  Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive.
  
  
  METHODS
  Network meta-analysis was used to evaluate randomized controlled trials (RCT) which investigated antihypertensive treatments in ADPKD. PubMed, Embase, Ovid, and Cochrane Collaboration were searched. The primary outcome was estimated glomerular filtration rate (eGFR). Secondary outcomes were serum creatinine (Scr), urinary albumin excretion (UAE), systolic BP (SBP), diastolic BP (DBP), mean artery pressure (MAP) and left ventricular mass index (LVMI).
  
  
  RESULTS
  We included 10 RCTs with 1386 patients and six interventions: angiotensin-converting enzyme inhibitors (ACEI), Angiotensin II receptor blocker (ARB), combination of ACEI and ARB, calcium channel blockers (CCB), β-blockers and dilazep. There was no difference of eGFR in all the treatments in both network and direct comparisons. No significant differences of Scr, SBP, DBP, MAP, and LVMI were found in network comparisons. However, ACEI signiﬁcantly reduced SBP, DBP, MAP and LVMI when compared to CCB. Significantly increased UAE was observed in CCB compared with ACEI or ARB. Bayesian probability analysis found ARB ranked first in the surrogate measures of eGFR, UAE and SBP.
  
  
  CONCLUSIONS
  There is little evidence to detect differences of antihypertensive treatments on kidney disease progression in ADPKD patients. More RCTs will be needed in the future. Use of ARB may be an optimal choice in clinical practice.
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.|Department of Nephrology, PLA 309 Hospital, Beijing, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Xue
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chenchen
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Dai
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Shengqiang
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chenggang
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Ye
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Dongping
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.|Department of Pharmacy, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Wansheng
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
mesh_terms: 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; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: Pathology Section; antihypertensive drug; autosomal dominant; glomerular filtration rate; polycystic kidney disease; urinary albumin excretion