Key result
Combining ACE inhibitors and ARBs lacks clinical evidence for hypertension pending large outcome studies.
Why the study?
Does ACE inhibitor and ARB combination therapy improve outcomes compared to monotherapy in patients with hypertension or proteinuric renal disease?
Does ACE inhibitor and ARB combination therapy improve outcomes compared to monotherapy in patients with hypertension or proteinuric renal disease?
The routine combination of ACE inhibitors and ARBs lacks strong clinical evidence for hypertension, pending results from large outcome studies.
ACEI-ARB combination lacks clinical evidence in hypertension; leaves open optimal RAS inhibition strategy for proteinuric renal disease.
ACE Inhibitors (ACEI) and angiotensin receptor blockers (ARB) inhibit the renin-angiotensin system, but ACEI may do so incompletely when administered as monotherapy at conventional doses. In theory, combining an ACEI and ARB might be beneficial, whereas clinical evidence for this approach in hypertension is lacking. An ACEI-ARB combination is likely to be useful in proteinuric renal disease, but recent experimental evidence suggests that very high dose monotherapy with an ARB may be the best approach. However, the results of large outcome studies for combinations vs. ACEI or ARB monotherapy are still awaited.
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Timothy Doulton (2006) conducted a review in Hypertension and proteinuric renal disease. ACE Inhibitor-Angiotensin Receptor Blocker Combinations vs. ACEI or ARB monotherapy was evaluated. Clinical evidence for combining an ACE inhibitor and an angiotensin receptor blocker in hypertension is lacking, and results of large outcome studies are still awaited.
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