Does Evidence Support Renin–Angiotensin System Blockade for Slowing Nephropathy Progression in Elderly Persons?
Authors: Pantelis A. Sarafidis
Journal: Annals of Internal Medicine (2009)

Editorials19 May 2009Does Evidence Support Renin–Angiotensin System Blockade for Slowing Nephropathy Progression in Elderly Persons?Pantelis A. Sarafidis, MD, MSc, PhD and George L. Bakris, MDPantelis A. Sarafidis, MD, MSc, PhDFrom AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54006, Greece; and University of Chicago, Pritzker School of Medicine, Chicago, IL 60637. and George L. Bakris, MDFrom AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54006, Greece; and University of Chicago, Pritzker School of Medicine, Chicago, IL 60637.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-10-200905190-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Authoritative practice guidelines recommend agents that block the renin–angiotensin system (RAS) as first-line therapy for patients with chronic kidney disease (CKD) (1–3). The evidence to support these recommendations comes from more than 2 decades of studies, as well as from several randomized trials demonstrating that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers slow CKD progression more effectively than other antihypertensive agents (4–6). All of these nephropathy outcome trials define "benefit" as a slowed time to doubling of serum creatinine level, dialysis, or death.All of the trials favoring use of RAS blockers to slow nephropathy progression have similar study populations. Specifically, ...References1. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43 5 Suppl 1 1-290. [PMID: 15114537] MedlineGoogle Scholar2. 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Int Urol Nephrol. 2006;38:787-93. [PMID: 17160631] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki 54006, Greece; and University of Chicago, Pritzker School of Medicine, Chicago, IL 60637.Disclosures:Consultancies: G.L. Bakris (Abbott, Takeda, GlaxoSmithKline, Boehringer Ingelheim, Gilead, Novartis, Merck & Co.). Grants received: G.L. Bakris (National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, GlaxoSmithKline, Forest, Juvenile Diabetes Foundation). Grants pending: G.L. Bakris (National Institutes of Health, Alternative Medicine Institute).Corresponding Author: George L. Bakris, MD, University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637; e-mail, [email protected]com.Current Author Addresses: Dr. Sarafidis: AHEPA Hospital, Aristotle University of Thessaloniki, First Kiriakidi Street, Thessaloniki 54006, Greece.Dr. Bakris: University of Chicago, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCurrent Guidelines for Using Angiotensin-Converting Enzyme Inhibitors and Angiotensin II–Receptor Antagonists in Chronic Kidney Disease: Is the Evidence Base Relevant to Older Adults? Ann M. O'Hare , James S. Kaufman , Kenneth E. Covinsky , C. Seth Landefeld , Lynne V. McFarland , and Eric B. 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