Dual renin–angiotensin system blockade: In patients with single functioning kidney and proteinuria

Robles, Nicolás Roberto; Jiménez, Belkys; Gallego, Román Hernández; Ruiz-Calero, Rosa; Casado, E. Sánchez; Cubero, Juan José

doi:10.1016/j.ejim.2008.06.002

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…A meta-analysis / metaregression of trials in patients with primary glomerulonephritis showed that the antiproteinuric response to ACE inhibitor plus ARB therapy versus either monotherapy is consistently greater and strictly related to baseline proteinuria, associated with only moderate increase in serum potassium levels and not peculiar to immunoglobulin A nephropathy [82]. In a retrospective analysis of 6-month data from 16 patients with a single kidney and proteinuria, dual RAS blockade with several different ACE inhibitors and ARBs at the maximal dose tolerated by the patient did not affect plasma creatinine levels or creatinine clearance, but also did not reduce proteinuria, suggesting lack of benefit in these patients [83]. In a meta-analysis of 49 randomized trials, which excluded the combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE) trial (which was retracted due to serious concerns about the study data), monotherapy with ARBs and ACE inhibitors was reported to delay progression of proteinuria over both the short (1–4 months) and longer (5–12 months) term [84].…”

Section: Introductionmentioning

confidence: 99%

Dual renin-angiotensin system inhibition for prevention of renal and cardiovascular events: do the latest trials challenge existing evidence?

Mallat

2013

Cardiovasc Diabetol

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Circulatory and tissue renin-angiotensin systems (RAS) play a central role in cardiovascular (CV) and renal pathophysiology, making RAS inhibition a logical therapeutic approach in the prevention of CV and renal disease in patients with hypertension. The cardio- and renoprotective effects observed with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) monotherapy, together with the availability of a direct renin inhibitor (DRI), led to the investigation of the potential benefits of dual RAS inhibition. In small studies, ARB and ACE inhibitor combinations were shown to be beneficial in patients with CV or renal disease, with improvement in surrogate markers. However, in larger outcome trials, involving combinations of ACE inhibitors, ARBs or DRIs, dual RAS inhibition did not show reduction in mortality in patients with diabetes, heart failure, coronary heart disease or after myocardial infarction, and was in fact, associated with increased harm. A recent meta-analysis of all major trials conducted over the past 22 years involving dual RAS inhibition has clearly shown that the risk-benefit ratio argues against the use of dual RAS inhibition. Hence, the recent evidence clearly advocates against the use of dual RAS inhibition, and single RAS inhibition appears to be the most suitable approach to controlling blood pressure and improving patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Dual renin-angiotensin system inhibition for prevention of renal and cardiovascular events: do the latest trials challenge existing evidence?

Mallat

2013

Cardiovasc Diabetol

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“…Several authors have reported a superior effect of the combination of ACE inhibition and ARB on microalbuminuria/macroalbuminuria in patients with primary nephropathies [152][153][154][155][156] and in diabetic patients. 157,158 Two meta-analyses have addressed this issue suggesting that concomitant therapy with an ARB and an ACEI leads to greater reductions in proteinuria than monotherapy without excessive side effects.…”

Section: High Dosesmentioning

confidence: 99%

Renin–Angiotensin System Blocking Drugs

Robles

Cerezo

Hernández-Gallego

2013

J Cardiovasc Pharmacol Ther

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The two major classes of drugs that target the RAS are the angiotensin-converting enzyme (ACE) inhibitors and the selective AT1 receptor blockers (ARBs). Although both of these drug classes target angiotensin II, the differences in their mechanisms of action have implications for their effects on other pathways and receptors that may have therapeutic implications. Both ACEIs and ARBs are effective antihypertensive agents that have been shown to reduce the risk of cardiovascular and renal events. Direct inhibition of renin -the most proximal aspect of the RAS -became clinically feasible from 2007 with the introduction of aliskiren. This latter drug has been shown to be efficacious for the management of hypertension. Combined therapy of direct renin-inhibitors with ACEIs or ARBs has been tested in some clinical situations as congestive HF and proteinuria with diverse results. This article tries to offer an updated review of current knowledge on the use of RAS blocking drugs in clinical settings.

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Dual renin–angiotensin system blockade: In patients with single functioning kidney and proteinuria

Cited by 2 publications

References 21 publications

Dual renin-angiotensin system inhibition for prevention of renal and cardiovascular events: do the latest trials challenge existing evidence?

Dual renin-angiotensin system inhibition for prevention of renal and cardiovascular events: do the latest trials challenge existing evidence?

Renin–Angiotensin System Blocking Drugs

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