Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Renin–angiotensin system

Meta-analyses can misdirect decisions on treatment

Nature Reviews Nephrology volume 9, pages 311–312 (2013)Cite this article

Subjects

A recent meta-analysis concluded that the risk-to-benefit ratio of dual (versus single-drug) renin–angiotensin system blockade argues against the use of dual therapy. This conclusion, however, seems inconsistent with the actual data and may convey to physicians a misleading message that could misdirect important decisions on treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Effects of dual versus single-drug renin–angiotensin system blockade according to actual data from different subgroups included in meta-analysis.

References

  1. Makani, H., Bangalore, S., Desouza, K.A., Shah, A. & Messerli, F. H. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ http://dx.doi.org/10.1136/bmj.f360.

  2. Werner, C. et al. RAS blockade with ARB and ACE inhibitors: current perspective on rationale and patient selection. Clin. Res. Cardiol. 97, 418–431 (2008).

    Article  CAS  Google Scholar 

  3. Ruggenenti, P., Cravedi, P. & Remuzzi, G. Mechanisms and treatment of CKD. J. Am. Soc. Nephrol. 23, 1917–1928 (2012).

    Article  CAS  Google Scholar 

  4. Menard, J., Campbell, D.J., Azizi, M. & Gonzales, M. F. Synergistic effects of ACE inhibition and Ang II antagonism on blood pressure, cardiac weight, and renin in spontaneously hypertensive rats. Circulation 96, 3072–3078 (1997).

  5. Zoja, C. et al. How to fully protect the kidney in a severe model of progressive nephropathy: a multidrug approach. J. Am. Soc. Nephrol. 13, 2898–2908 (2002).

    Article  CAS  Google Scholar 

  6. McMurray, J.J. et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 362, 767–771 (2003).

    Article  CAS  Google Scholar 

  7. Ruggenenti, P. et al. Role of remission clinics in the longitudinal treatment of CKD. J. Am. Soc. Nephrol. 19, 1213–1224 (2008).

    Article  Google Scholar 

  8. Parving, H.H. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 367, 2204–2213 (2012).

    Article  CAS  Google Scholar 

  9. Sever, P. Hypotension and ischaemic stroke associated with aliskiren in the ALTITUDE trial: sensitisation of the Bezold-Jarisch reflex? J. Renin Angiotensin Aldosterone Syst. 14, 1–2 (2013).

    Article  Google Scholar 

  10. Cravedi, P., Ruggenenti, P. & Remuzzi, G. Proteinuria should be used as a surrogate in CKD. Nat. Rev. Nephrol. 8, 301–306 (2012).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Via Stezzano 87, Bergamo, 24126, Italy

    Piero Ruggenenti & Giuseppe Remuzzi

Authors
  1. Piero Ruggenenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Remuzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Remuzzi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruggenenti, P., Remuzzi, G. Meta-analyses can misdirect decisions on treatment. Nat Rev Nephrol 9, 311–312 (2013). https://doi.org/10.1038/nrneph.2013.82

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2013.82

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing