Table 4

Results of clinical trials indicating the renoprotective nature of ARBs






Principle findings

AMADEO® [122]

Hypertension and diabetic nephropathy


Telmisartan or losartan

52 weeks

Telmisartan was superior to losartan in reducing proteinuria

CALM [25]

Type 2 diabetes with hypertension and microalbuminuria


Candesartan, lisinopril or both

24 weeks

Candesartan was as effective as lisinopril in reducing UACR. Combined treatment was associated with a greater reduction in UACR than monotherapeutic treatment (statistically significant versus candesartan monotherapy)

DETAIL® [99]

Hypertension, Type 2 diabetes and early nephropathy


Telmisartan or enalapril

5 years

Telmisartan was not inferior to enalapril in providing long-term renoprotection

IDNT [119]

Hypertension and diabetic nephropathy


Irbesartan, amlodipine or placebo

Mean 2.6 years

Irbesartan was superior to amlodipine and placebo in preventing the primary composite end point of: a doubling of the base-line serum creatinine concentration, the development of ESRD, or death from any cause. This was independent of BP

IRMA 2 [118]

Hypertension, type 2 diabetes and microalbuminuria


Irbesartan or Placebo

2 years

Irbesartan was superior to placebo in preventing diabetic nephropathy

MARVAL [121]

Diabetic nephropathy with and without hypertension


Valsartan or amlodipine

24 weeks

Valsartan was superior to amlodipine in reducing microalbuminuria

RENAAL [120]

Diabetic nephropathy


Losartan or placebo

Mean 3.4 years

Losartan was superior to placebo in preventing increases in UACR and progression to ESRD. There was no difference in mortality


Type 2 diabetes with normoalbuminuria


Olmesartan or placebo

Median 3.2 years

Olmesartan delayed the time to onset of microalbuminuria (statistical significance lost on adjustment for blood pressure difference)

VIVALDI® [124]

Hypertension and diabetic nephropathy


Telmisartan or valsartan*

52 weeks

Telmisartan and valsartan provided similar renoprotection

Abbreviations: AMADEO® = A trial to compare telMisartan 40 mg titrated to 80 mg versus losArtan 50 mg titrated to 100 mg in hypertensive type 2 DiabEtic patients with Overt nephropathy; ARB = angiotensin II receptor blocker; BP = blood pressure; CALM = CAndesartan and Lisinopril Microalbuminuria; DETAIL® = Diabetics Exposed to Telmisartan And enalaprIL study; ESRD, end-stage renal disease; IDNT = Irbesartan type II Diabetic Nephropathy Trial; IRMA2 = IRbesartan in patients with type 2 diabetes and MicroAlbuminuria; MARVAL = MicroAlbuminuria Reduction with VALsartan trial; RENAAL = Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; ROADMAP = Randomized Olmesartan And Diabetes Microalbuminuria Prevention; UACR = urine albumin:creatinine ratio; VIVALDI® = A trial to inVestigate the efficacy of telmIsartan versus VALsartan in hypertensive type 2 DIabetic patients with overt nephropathy.

*Additional hypertensive treatment was allowed in VIVALDI®.

Mallat Cardiovascular Diabetology 2012 11:32   doi:10.1186/1475-2840-11-32

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