A multicenter, open-label trial was designed to evaluate the combination of an ACE inhibitor and an ARB versus either agent alone in type 2 diabetic nephropathy, with no results reported.
RCT
Open-label
Yes
Does the combination of an ACE inhibitor and an ARB reduce renal disease progression, proteinuria, and cardiovascular events compared to either agent alone in patients with type 2 diabetic nephropathy?
This paper describes the rationale and design of a trial comparing dual RAS blockade to monotherapy for preventing renal disease progression and cardiovascular events in type 2 diabetic nephropathy.
There is clear evidence that pharmacologic blockade of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) reduces proteinuria and slows the progression of renal disease in diabetic and nondiabetic nephropathies, a beneficial effect that is not related to BP control. Some patients exhibit a significant beneficial response, whereas others do not. The absence of response may be explained by the incomplete blockade of the RAS obtained with ACEI. In the search of new alternatives that could improve the antiproteinuric and nephroprotective effects of RAS blockers, the association of ACEI and ARB might prove useful. ARB produces a complete blockade of the RAS. Several studies have shown a more marked antiproteinuric effect of the dual blockade of the RAS versus ACEI or ARB alone. A recent study also demonstrated that this more marked antiproteinuric effect is associated with less progression of renal disease in primary nondiabetic nephropathies despite a similar effect on BP. Until now, there has not been any reference to a beneficial effect on progression of the dual blockade in type 2 diabetic nephropathy, which is the most frequent cause of ESRD. A multicenter, prospective, open, active-controlled, and parallel-group trial was designed to compare the effects of an ACE inhibitor versus an ARB or its combination on renal disease progression, proteinuria, and cardiovascular events in type 2 diabetic nephropathy.
Fernández‐Juárez et al. (Mon,) conducted a rct in Type 2 diabetic nephropathy. ACE inhibitor and ARB combination vs. ACE inhibitor or ARB alone was evaluated on Renal disease progression, proteinuria, and cardiovascular events. A multicenter, open-label trial was designed to evaluate the combination of an ACE inhibitor and an ARB versus either agent alone in type 2 diabetic nephropathy, with no results reported.