Why the study?
Does combination therapy with an ACE inhibitor and an ARB improve clinical outcomes compared to monotherapy in patients with hypertension, heart failure, or chronic kidney disease?
Does combination therapy with an ACE inhibitor and an ARB improve clinical outcomes compared to monotherapy in patients with hypertension, heart failure, or chronic kidney disease?
While biologically plausible and showing additive effects on surrogate markers, the routine clinical use of combined ACE inhibitor and ARB therapy requires definitive proof from ongoing large-scale outcomes trials.
Does not support routine combination ACE inhibitor/ARB use; leaves open targeted benefits in severe HF or proteinuric CKD.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are regularly prescribed for the management of hypertension. Each of these drug classes has also been shown to provide survival benefits for patients with heart failure, proteinuric chronic kidney disease, and/or a high cardiac risk profile. The individual gains seen with each of these drug classes have led to speculation that their combination might offer additive if not synergistic outcome benefits. The foundation of this hypothesis, although biologically possible, has thus far not been sufficiently well proven to support the everyday use of these 2 drug classes in combination. Additional outcomes trials, which are currently proceeding to their conclusion, may provide the necessary proof to support an expanded use of these 2 drug classes in combination.
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Domenic A. Sica (2007) studied this question.
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