Effects of combined ACE inhibitor and angiotensin II antagonist treatment in human chronic nephropathies

Abstract

At comparable blood pressure, combined ACEi and ARA decreased proteinuria better than ACEi and ARA. The greater antiproteinuric effect most likely depended on an ACEi-related hemodynamic effect, in addition to glomerular size selectivity amelioration. Long-term combined ACEi and ARA therapy may be more renoprotective than treatment with each agent alone.

Improvement of Blood Pressure Control in Hypertensive Patients with Renal Diseases

“…The improvement of BP control by using antihypertensive agents, such as ACE inhibitors or ARBs, has also been reported in previous studies (2,3,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). A significant increase in the prescription of ARBs was observed in 2003 compared with 1996 in RD patients.…”

“…Several studies have suggested that the combined treatment with ACE inhibitors and ARBs may be more renoprotective than treatment with either agent alone (12,(20)(21)(22)24), and, indeed, in some RD patients, the combination of ACE inhibitors and ARBs was also prescribed in the present study. The improvement of BP control by using antihypertensive agents, such as ACE inhibitors or ARBs, has also been reported in previous studies (2,3,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

“…Based on the findings obtained from the large-scale clinical trials (5,7), recent guidelines for the management of hypertension, such as JNC VI, JNC 7, WHO/ISH 1999, ESH-ESC 2003 and Japanese Society of Hypertension (JSH) 2004 recommend strict BP control in RD (8)(9)(10)(11). Moreover, the development of newer classes of antihypertensive drugs, such as angiotensin II receptor blockers (ARBs), has had a beneficial influence on the management of hypertension with RD (2,3,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Thus, the aim of the present study was to assess the current status of BP control in hypertensive patients with RD, and whether BP control improved during the period between 1996 and 2003, i.e., before and after the introduction of recent hypertension guidelines.…”

Combined Blockade of the Renin-Angiotensin System With Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Type 1 Receptor Antagonists

“…Combined RAS blockade with usual daily or even maximally recommended doses 59 of an ACE inhibitor and an AT1R antagonist reduced BP, 36,60 microalbuminuria, 36 and albuminuria 59,60 further than did single-site RAS blockade in patients with type 1 or type 2 diabetes. Similarly, in patients with nondiabetic proteinuric nephropathies, the hypotensive and antiproteinuric effects of combined RAS blockade were larger than those of single-site RAS blockade even when administered at high dose, 61 or the addition of an AT1R antagonist to a background of ACE inhibition had an additional hypotensive and antiproteinuric effect. 37,62,63 Although some studies have found a positive correlation between BP fall and albuminuria reduction in patients with chronic nephropathy, 59 which suggests that the nephroprotective effect of combined RAS blockade is in part due to changes in systemic, local, and glomerular capillary pressures as observed in experimental models, others have not.…”

Comparison of Higher Dose of Losartan Treatment with Losartan Plus Carvedilol and Losartan Plus Ramipril in Patients with Glomerulonephritis and Proteinuria

“…[4,5] Many studies have shown that a combination of these drugs could cause significantly greater antiproteinuric effect than either of these agents (i.e., ACEIs and AT1ras) as monotherapies. [15][16][17] Also, in most studies, it was proven that ACEI, AT1ra, or a combination of these drugs significantly decreased proteinuria and had renoprotective effects in patients with diabetic proteinuria. [3,6,18,19] AT1ra can reduce microalbuminuria in hypertensive renal transplant patients as well.…”