ARBs and ACEis together in the treatment of hypertension and its complications? current practical recommendations.
BACKGROUND
Arterial hypertension is highly prevalent in the general population. Its contribution to the development and evolution of cardiovascular and renal disease is well recognized. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) have demonstrated favorable effects on cardiovascular and renal prognosis; however, some limitations have been described, for example angiotensin and aldosterone breakthrough.


METHODS
This article describes several therapeutical strategies that can be administered with an ACEi or ARB, such as the direct renin inhibitors or the aldosterone receptor antagonists.


RESULTS
The addition of an ACEi to an ARB or vice versa was initially considered as a way of obtaining a stronger suppression of the renin-angiotensin-aldosterone system (RAAS), but recent evidence has shown that the combination of the two classes of drugs does not seem to afford the expected increase in benefit.


CONCLUSIONS
RAAS suppression with monotherapy is associated with beneficial cardiovascular effects, but has several limitations. Direct renin inhibitors and aldosterone receptor antagonists will increase the benefits of dual blockade. We need randomized trial data supporting reduction of cardiovascular events with an adequate safety profile using combination therapies.
Unidad de Hipertensión, Hospital 12 de Octubre, Av. Córdoba s/n, 28041 Madrid, Spain. ruilope@ad-hocbox.com
Luis M
LM
Ruilope
Julian
J
Segura
D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents