Key result
Combination therapy with benazepril and valsartan reduced proteinuria by a mean of 2.5 g/day, a significant decrease from baseline (p<0.05) that was not achieved with either monotherapy.
Why the study?
Does the combination of benazepril and valsartan reduce proteinuria more than monotherapy in patients with primary renal disease and hypertension?
RCT (n=36)
Open-label
randomised
Does the combination of benazepril and valsartan reduce proteinuria more than monotherapy in patients with primary renal disease and hypertension?
Absolute Event Rate: 2.5% vs 0.5%
p-value: p=<0.05
Combination therapy with an ACE inhibitor and an ARB significantly reduces proteinuria compared to monotherapy in patients with primary renal disease.
Combination ACEI/ARB therapy may be considered for greater proteinuria reduction in hypertensive primary renal disease; extends monotherapy evidence in this RCT.
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 decreases and 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.
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Segura et al. (2003) conducted an RCT in Primary renal disease with proteinuria (n=36). Benazepril plus valsartan vs. Benazepril or valsartan monotherapy was evaluated on Change in proteinuria during six months of follow-up (p=<0.05). Combination therapy with benazepril and valsartan reduced proteinuria by a mean of 2.5 g/day, a significant decrease from baseline (p<0.05) that was not achieved with either monotherapy.
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