Abstract
Blood pressure (BP) control is important to ameliorate cardiovascular events in patients with diabetes mellitus (DM). However, achieving the target BP with a single drug is often difficult. The objective of this study was to evaluate the antihypertensive effects of mineralocorticoid receptor antagonists (MRAs) as add-on therapy to renin–angiotensin system (RAS) inhibitor(s) in patients with hypertension and DM. Studies were searched through October 2014 in MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Randomized, controlled trials or prospective, observational studies regarding concomitant administration of MRA and RAS inhibitor(s) in patients with DM were included. Articles were excluded if the mean systolic BP (SBP) was <130 mm Hg before randomization for interventional studies or at baseline for prospective cohort studies. We identified nine eligible studies (486 patients): five randomized placebo-controlled trials; three randomized active drug-controlled trials; and one single-arm observational study. The mean differences in office SBP and diastolic BP (DBP) between the MRA and placebo groups were −9.4 (95% confidence interval (CI) −12.9 to −5.9) and −3.8 (95% CI, −5.5 to −2.2) mm Hg, respectively. Subgroup analysis results for study type, age, baseline office SBP and follow-up duration were similar to those of the main analysis. MRA mildly increased serum potassium (0.4 mEq l−1; 95% CI, 0.3–0.5 mEq l−1). A consistent reduction of albuminuria across these studies was also demonstrated. MRA further reduced SBP and DBP in patients with hypertension and DM already taking RAS inhibitors. Serum potassium levels should be monitored to prevent hyperkalemia.
Highlights
Hypertension and diabetes mellitus (DM), which commonly co-exist,1,2 are both established risk factors for cardiovascularrelated morbidity and mortality
Five placebo-controlled trials were included in the meta-analysis
The most important findings were that the addition of MRA to renin–angiotensin system (RAS) inhibitor (s) induces a significant additional reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) and reduces urinary albumin excretion, whereas marginally elevating plasma potassium concentrations
Summary
Hypertension and diabetes mellitus (DM), which commonly co-exist, are both established risk factors for cardiovascularrelated morbidity and mortality. When both are present, the risk for cerebrovascular disease and coronary artery disease significantly increases.. With intensive reduction in blood pressure (BP) in patients with DM, cardiovascular events, especially stroke, occur less often.. Strict BP control is important to reduce the cardiovascular risk in patients with DM. Because they reportedly protect renal function, renin–. BP control using monotherapy is often difficult in patients with DM; treatment with multiple drugs with different mechanisms for BP reduction is necessary. Angiotensin system (RAS) inhibitors, such as angiotensinconverting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), are recommended as first-line antihypertensive therapy for DM. BP control using monotherapy is often difficult in patients with DM; treatment with multiple drugs with different mechanisms for BP reduction is necessary.
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