This Article Free Full Text (Free PDF) Free References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Segura, J. Articles by Ruilope, L. M Search for Related Content PubMed PubMed Citation Articles by Segura, J. Articles by Ruilope, L. M Social Bookmarking                   What's this?

Combination is better than monotherapy with ACE inhibitor or angiotensin receptor antagonist at recommended doses

Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain, jsegurad{at}senefro.org

Manuel Praga

Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain

Carlos Campo

Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain

José L Rodicio

Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain

Luis M Ruilope

Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid, Spain

Objective

The combination of an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II (Ang II) receptor antagonist (ARB) could provide a higher degree of blockade of the renin-angiotensin system(RAS) than either agent alone. The primary aim of this study was to look at the effect of three therapeutic regimens (titrated ACE inhibitor (ACE-I) versus titrated ARB versus the combination of an ACE-I and an ARB) on the attainment of adequate blood pressure (BP) control and antiproteinuric effect. Both ACE-I and ARB were titrated as monotherapy up to the maximal recommended dose.

Methods

A pilot randomised, parallel group open-label study was conducted in 36 patients with primary renal disease, proteinuria above 1.5 g/day and BP >140/90 mmHg while on therapy with an ACE-I. Patients were randomly assigned to (1) benazepril, n=12; (2) valsartan, n=12; or (3) benazepril plus valsartan, n=12. Other antihypertensive therapies could also be added to attain goal BP (<140/90 mmHg). The primary endpoint was the change in proteinuria during six months of follow-up.

Results

In the presence of similar BP decreasesand stable creatinine clearance values, mean proteinuria decreases were 0.5±1.7, 1.2±2.0 and 2.5±1.8 g/day in groups 1, 2 and 3, respectively. When compared with baseline values, only the fall induced by the combination of ARB and ACE-I attained statistical significance (p<0.05).

Conclusion

The antiproteinuric capacity of monotherapy at recommended doses with either an ACE-I or an ARB is lower than that obtained with the combination of the two drugs.

Key Words: angiotensin-converting enzyme inhibitor • angiotensin receptor blocker • renin-angiotensin system inhibition • mild renal insufficiency • proteinuria

Journal of Renin-Angiotensin-Aldosterone System, Vol. 4, No. 1, 43-47 (2003)
DOI: 10.3317/jraas.2003.007


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				T. Berl Review: Renal protection by inhibition of the renin-angiotensin-aldosterone system Journal of Renin-Angiotensin-Aldosterone System, March 1, 2009; 10(1): 1 - 8. [Abstract] [PDF]

				R. Kunz, C. Friedrich, M. Wolbers, and J. F.E. Mann Meta-analysis: Effect of Monotherapy and Combination Therapy with Inhibitors of the Renin-Angiotensin System on Proteinuria in Renal Disease Ann Intern Med, January 1, 2008; 148(1): 30 - 48. [Abstract] [Full Text] [PDF]

				S. G. Tsouli, E. N. Liberopoulos, D. N. Kiortsis, D. P. Mikhailidis, and M. S. Elisaf Combined Treatment With Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Review of the Current Evidence Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2006; 11(1): 1 - 15. [Abstract] [PDF]

				V. L.M. Esnault, A. Ekhlas, C. Delcroix, M.-G. Moutel, and J.-M. Nguyen Diuretic and Enhanced Sodium Restriction Results in Improved Antiproteinuric Response to RAS Blocking Agents J. Am. Soc. Nephrol., February 1, 2005; 16(2): 474 - 481. [Abstract] [Full Text] [PDF]