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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


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