Reduction of proteinuria; combined effects of receptor blockade and low dose angiotensin-converting enzyme inhibition

Berger, Elke D.; Bader, Birgit; Ebert, Carola; Risler, T.; Erley, Christiane M.

doi:10.1097/00004872-200204000-00033

Cited by 41 publications

(22 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(n)ϭreference authors for further information being unsuccessful. 12,17 The combination of an ACEI and ARB reduced proteinuria by 30% (95% CI, 23% to 37%) compared with monotherapy with an ACE inhibitor, and by 39% (95% CI, 31% to 48%) compared with ARB monotherapy.…”

Section: Effects On Proteinuriamentioning

confidence: 99%

Systematic Review of Combined Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blockade in Hypertension

2005

View full text Add to dashboard Cite

Abstract-Some evidence suggests that long-term angiotensin-converting enzyme (ACE) inhibition may become less effective, thereby increasing angiotensin II levels, which could be inhibited by the addition of an angiotensin receptor blocker. We conducted a meta-analysis of randomized trials with searches of MEDLINE, EMBASE, and Cochrane databases. Overall, the combination of an ACE inhibitor and an angiotensin receptor blocker reduced ambulatory blood pressure by 4.7/3.0 mm Hg (95% confidence interval [CI], 2.9 to 6.5/1.6 to 4.3) compared with ACE inhibitor monotherapy and 3.8/2.9 mm Hg (2.4 to 5.3/0.4 to 5.4) compared with angiotensin receptor blocker monotherapy. Clinic blood pressure was reduced by 3.8/2.7 mm Hg (0.9 to 6.7/0.8 to 4.6) and 3.7/2.3 mm Hg (0.4 to 6.9/0.2 to 4.4) compared with ACE inhibitor and angiotensin receptor blocker, respectively. However, the majority of these studies used submaximal doses or once-daily dosing of shorter-acting ACE inhibitors and, when a larger dose of shorter-acting ACE inhibitor was given or a longer-acting ACE inhibitor was used, there was generally no additive effect of the angiotensin receptor blocker on blood pressure. Proteinuria was reduced by the combination compared with ACE inhibitor and angiotensin receptor blocker monotherapy, an effect that was independent of blood pressure in several studies, suggesting that the combination could have benefits in proteinuric nephropathies. None of the studies was of sufficient size and duration to determine whether there may be safety concerns. In conclusion, although there is a small additive effect on blood pressure with an ACE inhibitor-angiotensin receptor blocker combination, the routine use of this combination in uncomplicated hypertension is not recommended until more carefully controlled studies are performed. Key Words: angiotensin-converting enzyme Ⅲ hypertension Ⅲ meta-analysis Ⅲ proteinuria Ⅲ receptors, angiotensin Ⅲ renin-angiotensin system T he renin-angiotensin system (RAS) plays an important role in regulating blood pressure (BP). 1,2 Both angiotensinconverting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) inhibit the RAS and have been shown to be effective treatments for increased BP. 3 At the same time, they have other beneficial effects that may be independent of their ability to lower BP, for example, reductions in the progression of nephropathy in diabetes mellitus (DM) and chronic renal failure (CRF). 4 -6 Administration of ACEI causes plasma levels of angiotensin II (Ang II) to become undetectable, whereas there is some evidence that chronic administration of ACEI results in partial escape, ie, there is incomplete suppression of Ang II levels at peak, which may reduce the effectiveness of ACEI as BP-lowering agents. [7][8][9] Several studies have suggested that combining an ARB with an ACEI may provide a more complete blockade of the RAS in the treatment of diabetic and nondiabetic nephropathy and essential hypertension; in particular, it may lower BP and proteinuria furt...

show abstract

Section: Effects On Proteinuriamentioning

confidence: 99%

Systematic Review of Combined Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blockade in Hypertension

2005

View full text Add to dashboard Cite

show abstract

“…In 8- to 16-week trials in patients with diabetic nephropathy, combination-based therapy, compared with ACE inhibitor-based therapy, was well tolerated and had greater efficacy in reducing plasma aldosterone level, proteinuria, urinary transforming growth factor-β, albuminuria, and GFR; this has been demonstrated with various drug combinations, including lisinopril plus candesartan [24]; benazepril plus valsartan [25]; captopril, enalapril, or lisinopril plus irbesartan [26] or candesartan [27, 28]; enalapril plus irbesartan [29];perindopril plus irbesartan [30], and ramipril plus candesartan [31]. Similar results were found in trials including patients with nondiabetic nephropathies [32], including immunoglobulin A (IgA) nephropathy [33, 34] glomerulonephritis [35, 36], and primary glomerulonephritis and nonnephrotic proteinuria [37], and in trials in patients with various types of nephropathy, including diabetic nephropathy or glomerulonephritis [38], reflux nephropathy, IgA glomerulonephritis, focal sclerosis, diabetic nephropathy, membranous glomerulonephritis, lupus nephritis, other glomerulonephritis, Alport syndrome, and other conditions [39]. …”

Section: Combination Treatment With An Ace Inhibitor Plus An Arbmentioning

confidence: 69%

Rationale for Combination Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor Treatment and End-Organ Protection in Patients with Chronic Kidney Disease

Toto

Palmer

2007

Am J Nephrol

View full text Add to dashboard Cite

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.

show abstract

“…The primary findings in patients with nephropathy were very promising in smaller studies [27][28][29][30], but also in larger open label trials [31,32].…”

Section: Nondiabetic Nephropathymentioning

confidence: 91%

Dual blockade of the renin angiotensin system in diabetic and nondiabetic kidney disease

Andersen

2004

Current Science Inc

View full text Add to dashboard Cite

Dual blockade of the renin angiotensin system is based on a principle of obtaining the broadest and most efficient blockade of the effects of angiotensin II, by using the combination of an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II-receptor blocker (ARB). By combining two, different pharmacologic principles and inhibiting both the ACE and the angiotensin II type 1 receptor, it seems possible to block both the production and the action of angiotensin II, which would serve as efficient antihypertensive therapy. Exploring the beneficial effects of dual-blockade therapy is a work in rapid progress, in both diabetic and non-diabetic nephropathy. But evidence is also emerging in cardiovascular medicine, an overview of which is provided in this article.

show abstract

Reduction of proteinuria; combined effects of receptor blockade and low dose angiotensin-converting enzyme inhibition

Abstract: Candesartan promotes a complementary antiproteinuric and a small antihypertensive effect after a treatment period of 8 weeks in patients with chronic glomerulonephritis when given in conjunction with an ACEI. Renal hemodynamics did not vary significantly.

Cited by 41 publications

References 22 publications

Systematic Review of Combined Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blockade in Hypertension

Systematic Review of Combined Angiotensin-Converting Enzyme Inhibition and Angiotensin Receptor Blockade in Hypertension

Rationale for Combination Angiotensin Receptor Blocker and Angiotensin-Converting Enzyme Inhibitor Treatment and End-Organ Protection in Patients with Chronic Kidney Disease

Dual blockade of the renin angiotensin system in diabetic and nondiabetic kidney disease

Contact Info

Product

Resources

About