***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Angiotensin converting enzyme inhibitors and calcium antagonists are effective agents for controlling high blood pressure in diabetic patients . We selected 30 type II diabetic patients with proteinuria and evaluated the effect of these drugs on renal function and proteinuria . In a double-blind trial , patients received either 40 mg/day enalapril or 40 mg/day nifedipine during 12 months . They also received a hypoproteic diet with 0.8 g/kg wt/day of protein . In the enalapril group ( 10 men and eight women ) , mean arterial blood pressure was 112.0 + /- 12 mm Hg , creatinine clearance was 58.6 + /- 12.4 ml/min , and 24-hour proteinuria was 4.36 + /- 3.23 g/24 hr before treatment . After treatment , mean arterial blood pressure was 82.0 + /- 8.30 mm Hg ( p less than 0.001 ) , creatinine clearance was 66.6 + /- 13.8 ml/min ( NS ) , and 24-hour proteinuria was 0.56 + /- 0.78 g/24 hr ( p less than 0.001 ) . In the nifedipine group ( six men and six women ) , mean arterial blood pressure was 114.0 + /- 8.0 mm Hg , creatinine clearance was 67.8 + /- 19.6 ml/min , and 24-hour proteinuria was 2.84 + /- 1.31 g/24 hr before treatment . After treatment , mean arterial blood pressure was 86.0 + /- 7.0 mm Hg ( p less than 0.001 ) , creatinine clearance was 51.4 + /- 7.9 ml/min ( p less than 0.001 ) , and 24-hour proteinuria was 2.66 + /- 0.89 g/24 hr ( NS ) . These results show a similar hypotensive action and different renal effects between these two drugs after 12 months of treatment Background —Dyslipidemia frequently complicates chronic nephropathies and increases the risk of renal and cardiovascular events . This might be ameliorated by drugs , such as angiotensin-converting enzyme inhibitors , which effectively reduce proteinuria . Methods and Results —In this longitudinal study , we evaluated the extent to which uptitration of the ACE inhibitor lisinopril to maximum tolerated doses ( median [ range ] : 30 [ 10 to 40 ] mg/d ) ameliorated proteinuria and dyslipidemia in 28 patients with nondiabetic chronic nephropathies . Maximum lisinopril doses significantly and safely reduced proteinuria , serum total , LDL cholesterol , and triglycerides without substantially affecting serum HDL and renal hemodynamics . Proteinuria already decreased at 10 mg/d . Serum lipids progressively and dose-dependently decreased during uptitration to maximum doses . Reduction in total and LDL cholesterol correlated with increases in serum albumin/total protein concentration and oncotic pressure , peaked at lisinopril maximum doses , and persisted after treatment withdrawal . Despite less proteinuria reduction , hypercholesterolemia decreased more ( and reflected the increase in serum albumin ) in hypoalbuminemic than in normoalbuminemic patients who , despite more proteinuria reduction , had less decrease in cholesterol and no changes in serum albumin . Changes in serum triglycerides were independent of changes in serum proteins , were strongly correlated with lisinopril doses ( r = −0.89 , P = 0.003 ) and recovered promptly after treatment withdrawal . Lisinopril was well tolerated , did not affect renal hemodynamics , and caused symptomatic , reversible hypotension in only two patients . Conclusions —In chronic nephropathies , angiotensin converting enzyme inhibitor uptitration to maximum tolerated doses safely ameliorated hypertriglyceridemia by a direct , dose-dependent effect , and hypercholesterolemia through amelioration of the nephrotic syndrome , particularly in patients with more severe hypoalbuminemia Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Abstract Objectives : To assess and compare the effects of c and esartan or lisinopril , or both , on blood pressure and urinary albumin excretion in patients with microalbuminuria , hypertension , and type 2 diabetes . Design : Prospect i ve , r and omised , parallel group , double blind study with four week placebo run in period and 12 weeks ' monotherapy with c and esartan or lisinopril followed by 12 weeks ' monotherapy or combination treatment . Setting : Tertiary hospitals and primary care centres in four countries ( 37 centres ) . Participants : 199 patients aged 30 - 75 years . Interventions : C and esartan 16 mg once daily , lisinopril 20 mg once daily . Main outcome measures : Blood pressure and urinary albumin : creatinine ratio . Results : At 12 weeks mean ( 95 % confidence interval ) reductions in diastolic blood pressure were 9.5 mm Hg ( 7.7 mm Hg to 11.2 mm Hg , P<0.001 ) and 9.7 mm Hg ( 7.9 mm Hg to 11.5 mm Hg , P<0.001 ) , respectively , and in urinary albumin : creatinine ratio were 30 % ( 15 % to 42 % , P<0.001 ) and 46 % ( 35 % to 56 % , P<0.001 ) for c and esartan and lisinopril , respectively . At 24 weeks the mean reduction in diastolic blood pressure with combination treatment ( 16.3 mm Hg , 13.6 mm Hg to 18.9 mm Hg , P<0.001 ) was significantly greater than that with c and esartan ( 10.4 mm Hg , 7.7 mm Hg to 13.1 mm Hg , P<0.001 ) or lisinopril ( mean 10.7 mm Hg , 8.0 mm Hg to 13.5 mm Hg , P<0.001 ) . Furthermore , the reduction in urinary albumin : creatinine ratio with combination treatment ( 50 % , 36 % to 61 % , P<0.001 ) was greater than with c and esartan ( 24 % , 0 % to 43 % , P=0.05 ) and lisinopril ( 39 % , 20 % to 54 % , P<0.001 ) . All treatments were generally well tolerated . Conclusion : C and esartan 16 mg once daily is as effective as lisinopril 20 mg once daily in reducing blood pressure and microalbuminuria in hypertensive patients with type 2 diabetes . Combination treatment is well tolerated and more effective in reducing blood pressure In patients with diabetic nephropathy , lowering blood pressure and reducing proteinuria by over 30 % correlates with a slower progression to kidney failure . We compared two different angiotensin receptor-blockers in a double blind , prospect i ve trial of 860 patients with type 2 diabetes whose blood pressure levels was over 130/80 mmHg or who were receiving antihypertensive medication(s ) and who had a morning spot urinary protein to creatinine ratio of 700 or more . Patients were r and omized to telmisartan ( a highly lipophilic agent with a long half-life ) or losartan ( with low lipophilicity and short half-life ) . The primary endpoint was the difference in the urinary albumin to creatinine ratio between the groups at 52 weeks . The geometric coefficient of variation and the mean of the urinary albumin to creatinine ratio fell in both groups at 52 weeks but both were significantly greater for the telmisartan compared to the losartan cohort . Mean systolic blood pressure reductions were not significantly different between groups at trial end . We conclude that telmisartan is superior to losartan in reducing proteinuria in hypertensive patients with diabetic nephropathy , despite a similar reduction in blood pressure Increases in the cardiovascular risk marker microalbuminuria are attenuated by blood pressure reduction using blockers of the renin-angiotensin system . Such changes in microalbuminuria have not been observed when beta-blockers are used . A prespecified secondary end point of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives ( GEMINI ) trial was to examine the effects of different beta-blockers on changes in albuminuria in the presence of renin-angiotensin system blockade . Participants with hypertension and type 2 diabetes were r and omized to either metoprolol tartrate ( n=737 ) or carvedilol ( n=498 ) in blinded fashion after a washout period of all antihypertensive agents except for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers . Blinded medication was titrated to achieve target blood pressure , with a-5 month follow-up period . The current analysis examined microalbuminuria , using spot urine albumin : creatinine , in participants who had values at screening and trial end . A greater reduction in microalbuminuria was observed for those r and omized to carvedilol ( -16.2%Delta ; 95 % confidence interval , -25.3 , -5.9 ; P=0.003 ) . Of those with normoalbuminuria at baseline , fewer progressed to microalbuminuria on carvedilol versus metoprolol ( 20 of 302 [ 6.6 % ] versus 48 of 431 [ 11.1 % ] , respectively ; P=0.03 ) . Microalbuminuria development was not related to differences in blood pressure or achievement of blood pressure goal ( 68 % carvedilol versus 67 % , metoprolol ) . Presence of metabolic syndrome at baseline was the only independent predictor of worsening albuminuria throughout the study ( P=0.004 ) . Beta-blockers have differential effects on microalbuminuria in the presence of renin-angiotensin system blockade . These differences can not be explained by effects on blood pressure or alpha1-antagonism but may relate to antioxidant properties of carvedilol Treatment of hypertension with ACE inhibitors in diabetic patients reduces proteinuria and slows progression of nephropathy compared with agents that do not maintain declines in proteinuria . Calcium channel blockers ( CCBs ) have variable effects on proteinuria ; their long-term effects on progression of diabetic nephropathy are not known . The current study examines the hypothesis that CCBs that maintain reductions in proteinuria slow progression of nephropathy associated with non-insulin dependent diabetes mellitus ( NIDDM ) by a degree comparable to ACE inhibitors , given similar levels of blood pressure control . To test this hypothesis we r and omized 52 patients with NIDDM associated nephropathy and hypertension , mean age of 63 + /- 8 years , to either the ACE inhibitor , lisinopril ( N = 18 ) , nondihydropyridine CCBs ( NDCCBs ) , verapamil SR ( N = 8) or diltiazem SR ( N = 10 ) , or the beta blocker , atenolol ( N = 16 ) . Goal blood pressure was < or = 140/90 mm Hg . Patients were followed for a mean period of 63 + /- 7 months . The primary end point was change in creatinine clearance ( CCr ) slope in each group . There was no significant difference in mean arterial pressure reduction among the groups over the study period ( P = 0.14 ) . The mean rate of decline in CCr was greatest in the atenolol group ( -3.48 ml/min/year/1.73 m2 ; P < 0.0001 ) . There was no difference in the CCr slopes between lisinopril and NDCCBs groups ( P = 0.36 ) . Proteinuria was reduced to a similar extent in the lisinopril and NDCCBs groups ( P > 0.99 ) . Therefore , in persons with renal insufficiency secondary to NIDDM , similar levels of blood pressure control with either lisinopril or NDCCBs slowed progression of renal disease to a greater extent than atenolol . Moreover , this enhanced slowing of renal disease progression correlated with sustained and significant reductions in proteinuria , findings not observed in 
    Output:
    
Individual ACEIs and ARBs at goal doses showed no significant differences in ESRD and doubling of serum creatinine levels .
They also shared similar effects on albuminuria/proteinuria reduction and progression or remission of albuminuria .
When combining three outcomes of albuminuria/proteinuria as a single endpoint , most ACEIs/ARBs consistently showed favorable antiproteinuric effect , with little difference in the possibility of being the superior treatment for improving albuminuria/proteinuria .
Conclusions Based on the available evidence , individual ACEIs and ARBs at goal doses appeared to have no or little differences in their effect on major renal outcomes