Key result
ACEI plus ARB combination improves reno- and cardioprotection over monotherapy in select high-risk patients.
Why the study?
Combination renin-angiotensin system blockade may provide enhanced reno- and cardioprotection but its benefits appear limited to select patient groups and remain uncertain.
Does combination therapy with ACEIs and ARBs improve target-organ protection compared to monotherapy in select high-risk patient groups?
Does combination therapy with ACEIs and ARBs improve target-organ protection compared to monotherapy in select high-risk patient groups?
Combination RAS blockade with ACEIs and ARBs may offer enhanced target-organ protection in specific high-risk populations independent of blood pressure lowering.
May support dual RAS blockade for enhanced protection in select patients; leaves open optimal use and safety in broader populations.
Pharmacologic blockade of the renin-angiotensin-aldosterone system (RAS) has antihypertensive, anti-atherogenic, antioxidant, and anti-inflammatory effects. Treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) has been demonstrated to prevent atrial fibrillation and new-onset diabetes, and provide cardiac, cerebral, and renal protection. Combination therapy with ACEIs and ARBs, compared with monotherapy, provides enhanced reno- and cardioprotection, although available data indicate that combination RAS blockade may be beneficial only in select patient groups, such as those with diabetes mellitus, chronic kidney disease, or heart failure (HF). In certain high-risk patients, the use of ARBs provides comparable efficacy to that observed with ACEIs. The efficacy of these agents may stem from pleiotropic effects beyond blood pressure (BP) reduction. Several studies demonstrate achievement of clinical endpoints without significant effects on BP.
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L. Michael PrisantMD (2009) conducted a review in Diabetes mellitus, chronic kidney disease, or heart failure. Combination therapy with ACEIs and ARBs vs. Monotherapy was evaluated. Combination therapy with ACEIs and ARBs provides enhanced reno- and cardioprotection compared with monotherapy in select patient groups, such as those with diabetes, chronic kidney disease, or HF.
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