title: The enhanced renin-angiotensin-aldosteron system pharmacological blockade--which is the best?.
abstract: OBJECTIVE
  Pharmacological inhibition of renin-angiotensin-aldosteron system (RAAS) may reduce proteinuria and the rate of chronic kidney disease progression. The aim was to compare the effects on albuminuria of the therapy with either: (i) telmisartan 80 mg and aliskiren 300 mg, (ii) telmisartan 80 mg and eplerenone 50 mg, (iii) telmisartan 160 mg as monotherapy.
  
  
  METHODS
  Randomized, double-center, double-blind, cross-over, three treatments-three periods of 8 weeks each study. 18 patients with non-diabetic proteinuric CKD stage 1-3 completed the protocol.
  
  
  RESULTS
  There was significant difference in albuminuria between studied therapies (ANOVA; p<0.01). The combination therapy with telmisartan plus aliskiren decreased albuminuria more effectively than the treatment with telmisartan plus eplerenone and monotherapy with telmisartan 160 mg OD [376 mg/g creatinine (286-686) vs. 707 (502-1204) vs. 525 (318-763); post-hoc p<0.01 and p<0.05, respectively].
  
  
  CONCLUSIONS
  The study demonstrated that the combination therapy with angiotensin receptor blocker (ARB) and renin inhibitor was more effective in albuminuria lowering than the concomitant usage of ARB and mineralocorticoid receptor antagonist as well as than ARB in doses two-fold higher than usually used in treatment of hypertension in patients with non-diabetic CKD and that this higher antiproteinuric efficacy was independent on changes in blood pressure.
authors.affiliation: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland. leszek.tylicki@gumed.edu.pl
authors.forename: Leszek
authors.initials: L
authors.lastname: Tylicki
authors.forename: Sławomir
authors.initials: S
authors.lastname: Lizakowski
authors.forename: Przemysław
authors.initials: P
authors.lastname: Rutkowski
authors.forename: Marcin
authors.initials: M
authors.lastname: Renke
authors.forename: Beata
authors.initials: B
authors.lastname: Sulikowska
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Heleniak
authors.forename: Rafał
authors.initials: R
authors.lastname: Donderski
authors.forename: Rafał
authors.initials: R
authors.lastname: Bednarski
authors.forename: Milena
authors.initials: M
authors.lastname: Przybylska
authors.forename: Jacek
authors.initials: J
authors.lastname: Manitius
authors.forename: Bolesław
authors.initials: B
authors.lastname: Rutkowski
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000517:prevention & control; D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D001565:Benzoates / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D018592:Cross-Over Studies; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D000077545:Eplerenone; D005260:Female; D005650:Fumarates / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology / Q000517:prevention & control*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D012720:Severity of Illness Index; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000077333:Telmisartan; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles; D001565:Benzoates; D000077545:Eplerenone; D005650:Fumarates; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077333:Telmisartan; D000092502:Renin Inhibitors; C446481:aliskiren