Key result
Dual ACEi and ARB therapy reduces albuminuria an additional ~11-43% vs monotherapy in diabetic nephropathy.
Why the study?
Does dual blockade of the RAS with an ACE inhibitor and an ARB reduce albuminuria in patients with diabetic nephropathy compared to ACE inhibitor monotherapy?
Does dual blockade of the RAS with an ACE inhibitor and an ARB reduce albuminuria in patients with diabetic nephropathy compared to ACE inhibitor monotherapy?
Effect estimate: 11-43% reduction
Dual blockade of the RAS with an ACE inhibitor and an ARB provides additional reduction in albuminuria compared to monotherapy in diabetic nephropathy, though long-term clinical outcomes remain to be established.
May support further albuminuria reduction in diabetic nephropathy; leaves open effects on long-term clinical outcomes.
OBJECTIVE: To review the literature concerning dual blockade of the renin-angiotensin system (RAS) with an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) in diabetic nephrophathy. DATA SOURCES: MEDLINE (1998-September 2003), EMBASE (1998-September 2003), and International Pharmaceutical Abstracts (1998-September 2003) were used to access the literature. Search terms included angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, diabetic nephropathy, dual blockade, renin-angiotensin system, and combination therapy. DATA SYNTHESIS: Monotherapy with an ACE inhibitor provides incomplete blockade of the RAS. Dual blockade of the RAS has been studied in approximately 300 patients with diabetic nephropathy. Recent randomized controlled studies suggest that dual blockade using an ACE inhibitor and an ARB in diabetic nephropathy is well tolerated and will provide an additional 11-43% reduction in albuminuria versus monotherapy. CONCLUSIONS: Dual blockade of the RAS using an ACE inhibitor and an ARB provide statistically significant reductions in albuminuria and blood pressure. Use of dual blockade is safe, but requires additional monitoring for hyperkalemia. Long-term studies are needed to determine whether the decrease in albuminuria will correlate with an actual improvement from overt proteinuria to microalbuminuria or a decreased incidence of end-stage renal disease in the overall diabetic population.
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Wade et al. (2004) conducted a review in Diabetic nephropathy (n=300). Dual blockade of the renin-angiotensin system (ACE inhibitor and ARB) vs. Monotherapy with an ACE inhibitor was evaluated on Albuminuria (11-43% reduction). Dual blockade of the renin-angiotensin system using an ACE inhibitor and an ARB provides an additional 11-43% reduction in albuminuria versus monotherapy in diabetic nephropathy.
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