Reno-protective Effect of Angiotensin Receptor Blocker in Spontaneously Hypertensive Rat Models: A Systematic Review

Abstract

Background Chronic Kidney Disease (CKD) is highly prevalent among hypertensive population. Previous date from studies and experiments have confirmed the reno-protective effect and tolerability of angiotensin receptor blockers in diabetic nephropathy. However, clinical data are lacking in hypertensive population. Objectives This is the first meta-analysis to evaluate the surrogate outcomes of renal protection with ARBs in hypertensive rodents to serve as a baseline for further studies. Methods The systematic review was conducted following the PRISM checklist. Four different databases were searched including PubMed, EMBASE, ScienceDirect and SCOPUS. No restrictions were applied on dose, duration of follow up or ARBs used. Inclusion was restricted to experimental studies reporting means and SEM, published in English, addressing the PICO question and having a moderate to high quality. 37 total eligible articles were identified and Results: Of 25 reported primary outcomes in comparison to hypertensive untreated controls, 23 studies showed positive results supporting that ARBs induce reduction in proteinuria and/or albuminuria compared to hypertensive untreated controls. Similarly, in comparison to normotensive untreated controls, 9 of 12 studies showed positive results supporting that ARBs' induced reduction in proteinuria and/or albuminuria can reach levels similar to normotensive controls. For the secondary outcomes, 12 of 18 reported outcomes showed significant improvement in CrCl or reduction in BUN compared to hypertensive untreated rats. Similarly, 10 of 17 outcomes reported showed that the improvement in secondary outcomes reached levels that are comparable to normotensive controls. Conclusion: Qualitative data from this systematic review support that ARBs have a Reno-protective effect in different hypertensive models and the effect is independent of BP lowering.