Optimal renin–angiotensin system blockade—wishful thinking?

Makani, Harikrishna; Bangalore, Sripal; Messerli, Franz H.

doi:10.1038/nrcardio.2013.28-c1

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…Key points are presented in Box 2. We concur with the suggestion that optimal RAS blockade should be defined as the maximal blockade achieved without causing hyperkalemia, hypotension or renal dysfunction [Nussberger and Bohlender, 2013; Makani et al 2013b]. However, we lack predictive tests that allow definition of patient-specific optimal RAS blockade in advance.…”

Section: Conclusion and Steps Forwardsupporting

confidence: 73%

Combination use of medicines from two classes of renin–angiotensin system blocking agents: risk of hyperkalemia, hypotension, and impaired renal function

Esteras

Perez-Gomez

Rodríguez-Osorio

et al. 2015

Therapeutic Advances in Drug Safety

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European and United States regulatory agencies recently issued warnings against the use of dual renin–angiotensin system (RAS) blockade therapy through the combined use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) or aliskiren in any patient, based on absence of benefit for most patients and increased risk of hyperkalemia, hypotension, and renal failure. Special emphasis was made not to use these combinations in patients with diabetic nephropathy. The door was left open to therapy individualization, especially for patients with heart failure, when the combined use of an ARB and ACEI is considered absolutely essential, although renal function, electrolytes and blood pressure should be closely monitored. Mineralocorticoid receptor antagonists were not affected by this warning despite increased risk of hyperkalemia. We now critically review the risks associated with dual RAS blockade and answer the following questions: What safety issues are associated with dual RAS blockade? Can the safety record of dual RAS blockade be improved? Is it worth trying to improve the safety record of dual RAS blockade based on the potential benefits of the combination? Is dual RAS blockade dead? What is the role of mineralocorticoid antagonists in combination with other RAS blocking agents: RAAS blockade?

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Section: Conclusion and Steps Forwardsupporting

confidence: 73%