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January 1, 2002Journal of Hypertension

Additive antiproteinuric effect of combined ACE inhibition and angiotensin II receptor blockade

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Why the study?

Does the combination of fosinopril and irbesartan reduce proteinuria more than either drug alone in non-diabetic hypertensive patients with glomerulonephritis?

Population

n=10 non-diabetic hypertensive patients with glomerulonephritis, normal or slightly reduced but stable renal…

Comparison

Combination of fosinopril 20 mg/day and… vs Baseline, fosinopril 20 mg/day alone, and…

Design

RCT, random sequence

Follow-up

6 weeks per treatment period

Authors

PFPaolo FerrariUniversity of SienaHMHans‐Peter MartiNorwegian University of Science and TechnologyMPMarc PfisterUniversity Children’s Hospital Basel

Discussion

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Implication

Supports dual ACEI/ARB for greater proteinuria reduction in non-diabetic GN; confirms additive BP-independent effect in RCT.

Structured PICO

Does the combination of fosinopril and irbesartan reduce proteinuria more than either drug alone in non-diabetic hypertensive patients with glomerulonephritis?

P
Population
n=10 non-diabetic hypertensive patients with glomerulonephritis, normal or slightly reduced but stable renal function (creatinine clearance 40-106 ml/min) without immunosuppression.
I
Intervention
Combination of fosinopril 20 mg/day and irbesartan 150 mg/day for 6 weeks
C
Comparator
Baseline (no medication), fosinopril 20 mg/day alone, and irbesartan 150 mg/day alone (each for 6 weeks with 4-week washouts in a randomized crossover design)
O
Outcome
Proteinuria (g/24 h)surrogate

The combination of fosinopril and irbesartan produces a more profound decrease in proteinuria than either drug alone in patients with glomerulonephritis, independent of blood pressure changes.

Limitations

  • Requires long-term controlled study to confirm effect on progression of renal function loss

Cite This Study

Ferrari et al. (2002) studied this question.

synapsesocial.com/papers/6a6fde3431a3df8243282c35https://doi.org/10.1097/00004872-200201000-00018
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Blood Pressure Control, Proteinuria, and the Progression of Renal Disease1995 · 1,354 citations
  2. 2Reactive Hyperreninemia Is a Major Determinant of Plasma Angiotensin II During ACE Inhibition1990 · 170 citations
  3. 3Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy1982 · 763 citations
  4. 4Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe chronic heart failure1995 · 196 citations
  5. 5Dietary Protein Intake and the Progressive Nature of Kidney Disease:1982 · 2,080 citations