Evidence map›Paper›PMID 30948820›Full record

SynthesisHypertension research : official journal of the Japanese Society of Hypertension2019

Renin-angiotensin system inhibitors in hypertensive adults with non-diabetic CKD with or without proteinuria: a systematic review and meta-analysis of randomized trials.

Eikan Mishima, Yoshisuke Haruna, Hisatomi Arima

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Hypertension research : official journal of the Japanese Society of Hypertension, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 2 pooled it
4.5field-weighted citation impact, top 5% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
  4. The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Article
  5. Article
  6. Review
  7. Chronic kidney disease.Nature reviews. Disease primers · 2025
    Review
  8. Article
  9. Heterogeneous afferent arteriolopathy: a key concept for understanding blood pressure-dependent renal damage.Hypertension research : official journal of the Japanese Society of Hypertension · 2024
    Review
  10. Elucidating the complex interplay between chronic kidney disease and hypertension.Hypertension research : official journal of the Japanese Society of Hypertension · 2024
    Review
  11. Need to continue or discontinue RAS inhibitors as CKD stage advances? Any alternative?Hypertension research : official journal of the Japanese Society of Hypertension · 2023
    Article
  12. Article
  13. Endothelin Receptor Antagonists in Kidney Disease.International journal of molecular sciences · 2023
    Review
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 1 country.

Eikan MishimaDivision of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. eikan@med.tohoku.ac.jp.
Yoshisuke HarunaDepartment of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan.
Hisatomi ArimaDepartment of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Fukuoka University · JPKawasaki Medical School · JPTohoku University · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The efficacy and safety of renin-angiotensin system inhibitors (RAS-I) in hypertensive adults with non-diabetic chronic kidney disease (CKD) differ depending on the presence or the absence of proteinuria. To estimate the effects of RAS-I in this population, we performed a systematic review and meta-analysis of randomized controlled trials where treatment with angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers were compared with placebo or active controls in adults with non-diabetic CKD. The treatment effects were separately reviewed in patients with and without proteinuria. Based on a search of Medline and the Cochrane Library up to September 2017, we identified 42 eligible trials (28, proteinuria-positive group; 6, proteinuria-negative group; 2, mixed-proteinuria group; and 6, proteinuria data-unavailable group). RAS-I reduced renal failure events in comparison to placebo or active agents in the proteinuria-positive group (relative risk [RR] 0.63, 95% confidence interval [CI] 0.52-0.75), but showed no significant effects on renal failure risk in the proteinuria-negative group (RR 0.64, 95% CI 0.18-2.30) although it reduced microalbuminuria. For cardiovascular events, RAS-I was not associated with a significantly reduced risk in both the proteinuria-positive and proteinuria-negative group (RR 0.77 and 1.06, 95% CI 0.51-1.16 and 0.85-1.32, respectively). In the mixed-proteinuria group and proteinuria data-unavailable group, RAS-I showed no significant effects on renal and cardiovascular events. Among adverse events, hyperkalemia increased with RAS-I administration in the proteinuria-positive group (RR 2.01, 95% CI 1.07-3.77). Our analysis showed the renoprotective effects of RAS-I treatment in patients with non-diabetic CKD having proteinuria, supporting its use as the first-line antihypertensive therapy in this population.

Indexed as

AdultAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 2 Receptor BlockersAntihypertensive AgentsHumansHypertensionProteinuriaRandomized Controlled Trials as TopicRenal Insufficiency, ChronicRenin-Angiotensin SystemAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 2 Receptor BlockersAntihypertensive AgentsAngiotensin-converting enzyme inhibitorsAngiotensin II receptor blockersChronic kidney diseaseJSH 2019 guidelinesProteinuria

Identifiers

PMID30948820
OpenAlexW2931650530

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.