What evidence is available from the Micro-HOPE study to support the use of ACEi for people with diabetes and CKD G1 G3, A2?
The Micro-HOPE study provided evidence that people with diabetes, moderately increased albuminuria, and higher CV risks had improved CV outcomes when randomized to ACEi therapy compared to placebo. Specifically, for the composite outcome of MI, stroke, and CV death, there was a relative risk reduction with diabetes from the Micro-HOPE study, with a mean follow-up of 4.5 years. The study also found that baseline serum creatinine was 1.06 mg/dl (94 mmol/l), and 474 (14%) of 3238 people progressed to a serum creatinine level of $1.4 mg/dl (124 mmol/l) over the 4.5 years (231 on ramipril and 243 on placebo). Additionally, ACEi also reduces albuminuria in the CKD population with diabetes.