Safety of the combination of valsartan and benazepril in patients with chronic renal disease

Ruilope, Luis; Aldigier, Jean-Claude; Ponticelli, Claudio; Oddou-Stock, Pascale; Botteri, Florence; Mann, Johannes F.E.

doi:10.1097/00004872-200018010-00013

Cited by 171 publications

(106 citation statements)

References 21 publications

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“…In nondiabetic renal disease, a superior effect of dual blockade compared with single blockade were reported in several short-term open-label studies (27)(28)(29)(30). The COOPERATE trial (31) is the first long-term trial addressing the effect of dual blockade on primary renal end points.…”

Section: Discussionmentioning

confidence: 99%

Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy

Jacobsen¹,

Andersen²,

Jensen³

et al. 2003

Journal of the American Society of Nephrology

194

146

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Abstract. Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in diabetic patients. This study tested whether dual blockade of the renin-angiotensin system (RAS) with both an angiotensin-converting enzyme (ACE) inhibitor (ACE-I) and an Angiotensin-II receptor blocker (ARB) is superior to either drug alone in type I diabetic patients with diabetic nephropathy (DN). A randomized double-blind crossover trial was performed with 8-wk treatment with placebo, 20 mg of benazepril once daily, 80 mg of valsartan once daily, and the combination of 20 mg of benazepril and 80 mg of valsartan. Twenty type I diabetic patients with DN were included. At the end of each treatment period, albuminuria, 24-h BP, and GFR were measured. Eighteen patients completed the study. Placebo values were: albuminuria [mean (95% CI)], 701 (490 to 1002) mg/24 h; BP [mean (SEM)], 144 (4)/79 (2) mmHg, and GFR [mean (SEM)], 82 (7) ml/min per 1.73 m 2 . Treatment with benazepril, valsartan, or dual blockade significantly reduced albuminuria and BP compared with placebo. Benazepril and valsartan were equally effective. Dual blockade induced an additional reduction in albuminuria of 43 % (29 to 54 %) compared with any type of monotherapy, and a reduction in systolic BP of 6 (0 to 13) mmHg and 7 (1 to 14) mmHg (versus benazepril and valsartan, respectively) and a reduction of 7 (4 to 10) mmHg diastolic compared with both monotherapies. GFR was reversibly reduced on dual blockade compared with monotherapy and placebo. All treatments were safe and well tolerated. In conclusion, dual blockade of the RAS may offer additional renal and cardiovascular protection in type I diabetic patients with DN.Albuminuria and hypertension are predictors of poor renal and cardiovascular outcome in patients with diabetes (1,2). Antihypertensive treatment, especially ACE-I, has been shown to reduce albuminuria, to diminish loss of kidney function, and to improve survival in type I patients with DN (1-3). Studies of diabetic and nondiabetic kidney disease suggest the initial degree of reduction in albuminuria after blockade of the reninangiotensin system (RAS) predicts an attenuated rate of decline in GFR, as reviewed by Rossing (1). As a consequence, albuminuria may serve as a surrogate end point for monitoring treatment efficacy and prognosis in DN (4).A superior effect on BP and a tendency toward a more pronounced drop in urinary albumin excretion of dual blockade of the RAS compared with single blockade has been reported in type II patients with microalbuminuria (5). We have recently shown additional drop in albuminuria and diastolic BP when adding an angiotensin receptor blocker (ARB) to angiotensinconverting enzyme inhibitor (ACE-I) treatment in type l patients with albuminuria Ͼ1 g/24 h and BP Ͼ135/85 mmHg, despite conventional antihypertensive therapy including three different agents (6). However, this subgroup is highly selected; therefore, it may differ from the patients in general with DN, especially with regard to RAS activity and ...

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Section: Discussionmentioning

confidence: 99%

Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy

Jacobsen¹,

Andersen²,

Jensen³

et al. 2003

Journal of the American Society of Nephrology

194

146

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“…(6). In contrast, several studies suggested that ARBs slowed the progression of renal dysfunction in patients with type 2 diabetes (7,8) as well as non-diabetic nephropathy (9,10 i g u r e 1 . Ch a n g e s i n s e r u m c r e a t i n i n e .…”

Section: The Renin-angiotensin System (Ras) Plays An Important Role Imentioning

confidence: 98%

A Fiveyear Comparison of the Renal Protective Effects of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with NonDiabeticNephropathy

2006

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“…Based on this hypothesis of hyperfiltration, the effect of ACEI's in retarding the progression of renal disease independent of its antihypertensive effect has been the subject of many studies [9][10][11][12][13][14][15][16]. The use of ACEI's is recommended in all type 1 and type 2 diabetic patients with microalbuminuria.…”

Section: Definition Of Chronic Kidney Diseasementioning

confidence: 99%

“…Preliminary data suggests that angiotensin receptor blockers (ARB's) are probably as effective as ACEI's. Combined ACEI's and ARB's have been shown to further reduce the rate of progression of renal disease [14]. At present, their use is recommended in patients who can not achieve the goal of proteinuria <0.5gms/day, rate of decline of renal function< 2ml/mt/year and blood pressure of <130/80 mm/Hg [15].…”

Section: Definition Of Chronic Kidney Diseasementioning

confidence: 99%

Conservative Management of Chronic Renal Failure

Narula

Hooda

2007

Medical Journal Armed Forces India

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Safety of the combination of valsartan and benazepril in patients with chronic renal disease

Cited by 171 publications

References 21 publications

Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy

Additive Effect of ACE Inhibition and Angiotensin II Receptor Blockade in Type I Diabetic Patients with Diabetic Nephropathy

A Fiveyear Comparison of the Renal Protective Effects of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with NonDiabeticNephropathy

Conservative Management of Chronic Renal Failure

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