title: Dual blockade of the renin-angiotensin system in the progression of renal disease: the need for more clinical trials.
abstract: 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.
authors.affiliation: Department of Nephrology, Fundacion Hospital Alcorcon, C/Budapest 1 Alcorcon, Madrid 28922, Spain. gmfernandez@fhalcorcon.es
authors.forename: Gema
authors.initials: G
authors.lastname: Fernandez-Juárez
authors.forename: Vicente
authors.initials: V
authors.lastname: Barrio
authors.forename: Soledad García
authors.initials: SG
authors.lastname: de Vinuesa
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: José
authors.initials: J
authors.lastname: Luño
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors