A Systematic Review of Randomized Controlled Trials Examining the Nephroprotective Properties of Antihypertensive Medications

Leslie      Griffin; John      B. Standridge

Abstract

Introduction: Despite improved control rates of hypertension in the United States during the last thirty years, the rate of chronic kidney disease and end-stage renal disease has not demonstrated a similar resultant improvement.

Purpose: The purpose for this review is to determine interventions in the treatment of hypertension that improve outcomes in the promotion of nephroprotection.

Method: A systematic comprehensive search of the National Library of Medicine utilizing Medline was conducted with search limits confined to randomized controlled trials.

Results: Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are nephroprotective alone and in combination with other classes of antihypertensive agents, but can result in renal dysfunction when used in combination with each other or with a direct renin inhibitor (DRI). Older L-type calcium channel blockers (CCBs) can be nephrotoxic when used as monotherapy. CCBs are additionally nephroprotective when combined with ACEIs or ARBs. Thiazide-type diuretics (TTDs) with the exception of indapamide are not nephroprotective and TTDs may have nephrotoxic properties.

Conclusion: ACEIs and ARBs are preferred first-line agents because they are effective in the prevention of renal as well as cardiovascular and cerebrovascular target organ damage associated with hypertension. CCBs are preferred when a second medication is needed for hypertension control. When diuretic therapy is indicated for hypertension control, indapamide is preferred over other TTDs for nephroprotection.

Keywords: Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, antihypertensive medications, calcium channel blockers, diuretics, hypertension, nephroprotection, renoprotection, combination therapy, nephropathy, Glomerular hypertension.