Rationale for combination angiotensin receptor blocker and angiotensin-converting enzyme inhibitor treatment and end-organ protection in patients with chronic kidney disease.
Chronic kidney disease (CKD) is a major public health problem that has received increasing attention because of the high rate of associated cardiovascular morbidity and mortality. Mounting evidence indicates that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) safely slow down progression of CKD. There is also growing evidence supporting combination treatment of nephropathies with an ACE inhibitor plus an ARB to more completely block the RAAS and provide greater renoprotection than either an ACE inhibitor-based or ARB-based regimen. The National Kidney Foundation suggests that ACE inhibitors and ARBs may be used in combination to reduce proteinuria in patients with kidney disease; however, larger outcomes trials are needed.
Toto
Robert
R
Patient-Oriented Research - Nephrology, University of Southwestern Medical Center at Dallas, Dallas, TX 75225-8856, USA. robert.toto@utsouthwestern.edu
Palmer
Biff F
BF
D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D008901:Mineralocorticoids / Q000037:antagonists & inhibitors; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012084:Renin-Angiotensin System / Q000187:drug effects; D000092502:Renin Inhibitors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D008901:Mineralocorticoids; D000092502:Renin Inhibitors