Trial reportBMJ (Clinical research ed.)2004
Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study).
Trial report in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 73 papers, 26 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
73 citing papers in PubMed, 26 syntheses or guidelines pooled it, 291 citations in OpenAlex.
- Pharmacotherapy for mild hypertension.The Cochrane database of systematic reviews · 2025Pooled it
- Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease.The Cochrane database of systematic reviews · 2024Pooled it
- ACEI and ARB Lower the Incidence of End-Stage Renal Disease among Patients with Diabetic Nephropathy: A Meta-analysis.Computational and mathematical methods in medicine · 2022Pooled it
- Treatments for Chronic Kidney Disease: A Systematic Literature Review of Randomized Controlled Trials.Advances in therapy · 2022Pooled it
- Effects of renin-angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials.Journal of endocrinological investigation · 2020Pooled it
- Addressing Regional Differences in Diabetes Progression: Global Calibration for Diabetes Simulation Model.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2019Pooled it
- Pharmacotherapy for hypertension in adults 60 years or older.The Cochrane database of systematic reviews · 2019Pooled it
- First-line drugs for hypertension.The Cochrane database of systematic reviews · 2018Pooled it
- Pooled it
- Effects of anti-hypertensive treatment on major cardiovascular events in populations within prehypertensive levels: a systematic review and meta-analysis.Journal of human hypertension · 2018Pooled it
- Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis.JAMA internal medicine · 2018Pooled it
- Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals.The Cochrane database of systematic reviews · 2016Pooled it
- Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses.BMJ (Clinical research ed.) · 2016Pooled it
- Assessing the Validity of Surrogate Outcomes for ESRD: A Meta-Analysis.Journal of the American Society of Nephrology : JASN · 2015Pooled it
- Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis.BMJ (Clinical research ed.) · 2013Pooled it
- Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.BMJ (Clinical research ed.) · 2013Pooled it
- Prevention of chronic kidney disease and subsequent effect on mortality: a systematic review and meta-analysis.PloS one · 2013Pooled it
- Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis.Diabetologia · 2012Pooled it
- Pooled it
- Early change in proteinuria as a surrogate outcome in kidney disease progression: a systematic review of previous analyses and creation of a patient-level pooled dataset.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2011Pooled it
13 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate whether a low dose of the angiotensin converting enzyme (ACE) inhibitor ramipril lowers cardiovascular and renal events in patients with type 2 diabetes who have microalbuminuria or proteinuria.
designRandomised, double blind, parallel group trial comparing ramipril (1.25 mg/day) with placebo (on top of usual treatment) for cardiovascular and renal outcomes for at least three years.
settingMulticentre, primary care study conducted mostly by general practitioners in 16 European and north African countries.
participants4912 patients with type 2 diabetes aged >50 years who use oral antidiabetic drugs and have persistent microalbuminuria or proteinuria (urinary albumin excretion > or = 20 mg/l in two consecutive samples), and serum creatinine < or = 150 micromol/l.
main outcome measuresThe primary outcome measure was the combined incidence of cardiovascular death, non-fatal myocardial infarction, stroke, heart failure leading to hospital admission, and end stage renal failure.
resultsParticipants were followed for 3 to 6 (median 4) years. There were 362 primary events among the 2443 participants taking ramipril (37.8 per 1000 patient years) and 377 events among the 2469 participants taking placebo (38.8 per 1000 patient years; hazard ratio 1.03 (95% confidence interval 0.89 to 1.20, P = 0.65)). None of the components of the primary outcome was reduced. Ramipril lowered systolic and diastolic blood pressures (by 2.43 and 1.06 mm Hg respectively after two years) and favoured regression from microalbuminuria (20-200 mg/l) or proteinuria (> 200mg/l) to normal level (< 20 mg/l) or microalbuminuria (P < 0.07) in 1868 participants who completed the study.
conclusionsLow dose (1.25 mg) ramipril once daily has no effect on cardiovascular and renal outcomes of patients with type 2 diabetes and albuminuria, despite a slight decrease in blood pressure and urinary albumin. The cardiovascular benefits of a daily higher dose (10 mg) ramipril observed elsewhere are not found with an eightfold lower daily dose.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.