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Author Topic: ACEi and ARB therapy for non-hypertensive patients with microalbuminuria
Tejas
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Posts: 37
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Post ACEi and ARB therapy for non-hypertensive patients with microalbuminuria
on: April 8, 2012, 19:21
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I just read an article in Prescribers Letter (link). It seems that they are no longer recommending ACE-I or ARBs in patients with MICROalbumuria without hypertension. This is all news to me. Do you go along with this? Thanks
Bob

Tejas
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Posts: 37
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Post Re: ACEi and ARB therapy for non-hypertensive patients with microalbuminuria
on: April 9, 2012, 08:20
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Hi Dr. T.

I was aware of the increased CV risks of using ACEi + ARB therapy as shown in the ONTARGET study. I was unaware of the other studies indicated in Prescribers Letter (i.e., BENEDICT, ROADMAP, ALTITUDE, ACCOMPLISH, ADVACE). However, a quick read of the inclusion criteria for these studies indicates that the patient selected had albuminuria and HTN.

Thus, the Letter is technically correct that there is insufficient evidence to use ACEi or ARB (or both) in the treatment of microalbuminuria in non-hypertensive patients because there seems to be no trials addressing this small population (+ microalbuminuria but negative for hypertension).

I think we should consider delving deeper into the trials mentioned in the Letter. Specifically, to what degree of reduction in micro or macroalbuminuria with ACEi or ARB will lead to a substantial (or statistically significant) increase in cardiovascular risk? Or are the patient selected in the ACEi/ARB arms always sicker than the comparator?

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Posts: 177
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Post Re: ACEi and ARB therapy for non-hypertensive patients with microalbuminuria
on: April 10, 2012, 16:14
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most important than that, i think we should search the aetiology of this microalbuminuria and treat it, cardiopathy, obesity, inflammatory syndrome...

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