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Curriculum Update # 7

• Managing renal disease for risk reduction: The expanding role of ACE inhibition

Chronic renal disease is a problem of increasing magnitude in the United States. This curriculum update discusses the findings in recent clinical studies of angiotensin-converting enzyme inhibition (ACE) in patients with renal disease. The results of these studies support an expanding role for ACE inhibition in the management of renal disease in increasingly diverse patient populations. The following areas are highlighted in this curriculum update:

  • A comparison of ACE inhibition and calcium channel blockade in the management of hypertensive renal nephrosclerosis: an interim report from the African American Study of Kidney Disease
  • Treatment of patients with nondiabetic renal disease employing regimens that include ACE inhibitors compared with those that do not: findings of a meta-analysis including 11 trials and 2180 patients
  • Reduction of cardiovascular risk with ramipril in patients with renal insufficiency and diabetes: findings of a HOPE subgroup analysis



Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine. Supported by an unrestricted educational grant from Wyeth-Ayerst Laboratories and Monarch Pharmaceuticals.

©2001 MEDCON

The editorial content of this program expresses the views of the individual contributors and does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, Wyeth-Ayerst Laboratories, Monarch Pharmaceuticals, or the publisher. The indications and dosages of drugs discussed in this program may vary from those approved by the Food and Drug Administration (FDA). The reader is advised to consult the full prescribing information for each medication prior to use.


Recent studies of ACE inhibition in renal disease

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Recent studies of ACE inhibition in renal disease AASK: Study design AASK: Cumulative incidence of renal events and death AASK: Rates of clinical events AASK: Mean change in GFR by baseline UP/Cr AASK: Mean change in GFR by baseline GFR AASK: % changes in proteinuria from baseline AASK: Conclusion and clinical implications ACE inhibition slows the progression of nondiabetic renal disease: A meta-analysis of 11 trials Risk for ESRD or combined outcome according to baseline urinary protein excretion Relative risk adjusted for treatment effect on BP and proteinuria: ACEI group vs control Conclusion and clinical implications HOPE subgroup analysis: Baseline characteristics of patients with and without renal insufficiency HOPE: Mild renal insufficiency increases the risk of CV events HOPE: Rate of primary outcome (CV death, MI, or stroke) by baseline serum creatinine quartile MICRO-HOPE: Effect of ACE inhibition on renal and CV outcomes in type 2 diabetes Recently completed studies of ARBs in patients with type 2 diabetes and renal disease HOPE: ACE inhibition reduces CV risk in patients with and without renal insufficiency HOPE: ACEI reduces CV events in patients w/wo renal insufficiency and diabetes or hypertension HOPE: Conclusions and clinical implications

ACECurriculumexpandinginhibitionmagnituderenalStates

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