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Dual blockade of the renin-angiotensin system in diabetic nephropathy.
Ann Pharmacother. 2004 Jul-Aug; 38(7-8):1278-82.AP

Abstract

OBJECTIVE

To review the literature concerning dual blockade of the renin-angiotensin system (RAS) with an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) in diabetic nephrophathy.

DATA SOURCES

MEDLINE (1998-September 2003), EMBASE (1998-September 2003), and International Pharmaceutical Abstracts (1998-September 2003) were used to access the literature. Search terms included angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, diabetic nephropathy, dual blockade, renin-angiotensin system, and combination therapy.

DATA SYNTHESIS

Monotherapy with an ACE inhibitor provides incomplete blockade of the RAS. Dual blockade of the RAS has been studied in approximately 300 patients with diabetic nephropathy. Recent randomized controlled studies suggest that dual blockade using an ACE inhibitor and an ARB in diabetic nephropathy is well tolerated and will provide an additional 11-43% reduction in albuminuria versus monotherapy.

CONCLUSIONS

Dual blockade of the RAS using an ACE inhibitor and an ARB provide statistically significant reductions in albuminuria and blood pressure. Use of dual blockade is safe, but requires additional monitoring for hyperkalemia. Long-term studies are needed to determine whether the decrease in albuminuria will correlate with an actual improvement from overt proteinuria to microalbuminuria or a decreased incidence of end-stage renal disease in the overall diabetic population.

Authors+Show Affiliations

St Louis College of Pharmacy, St Louis, MO 63110-1088, USA. vwade@stlcop.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15187210

Citation

Wade, Vicki L., and Brenda L. Gleason. "Dual Blockade of the Renin-angiotensin System in Diabetic Nephropathy." The Annals of Pharmacotherapy, vol. 38, no. 7-8, 2004, pp. 1278-82.
Wade VL, Gleason BL. Dual blockade of the renin-angiotensin system in diabetic nephropathy. Ann Pharmacother. 2004;38(7-8):1278-82.
Wade, V. L., & Gleason, B. L. (2004). Dual blockade of the renin-angiotensin system in diabetic nephropathy. The Annals of Pharmacotherapy, 38(7-8), 1278-82.
Wade VL, Gleason BL. Dual Blockade of the Renin-angiotensin System in Diabetic Nephropathy. Ann Pharmacother. 2004 Jul-Aug;38(7-8):1278-82. PubMed PMID: 15187210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual blockade of the renin-angiotensin system in diabetic nephropathy. AU - Wade,Vicki L, AU - Gleason,Brenda L, Y1 - 2004/06/08/ PY - 2004/6/10/pubmed PY - 2004/10/7/medline PY - 2004/6/10/entrez SP - 1278 EP - 82 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 38 IS - 7-8 N2 - OBJECTIVE: To review the literature concerning dual blockade of the renin-angiotensin system (RAS) with an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin II receptor blocker (ARB) in diabetic nephrophathy. DATA SOURCES: MEDLINE (1998-September 2003), EMBASE (1998-September 2003), and International Pharmaceutical Abstracts (1998-September 2003) were used to access the literature. Search terms included angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, diabetic nephropathy, dual blockade, renin-angiotensin system, and combination therapy. DATA SYNTHESIS: Monotherapy with an ACE inhibitor provides incomplete blockade of the RAS. Dual blockade of the RAS has been studied in approximately 300 patients with diabetic nephropathy. Recent randomized controlled studies suggest that dual blockade using an ACE inhibitor and an ARB in diabetic nephropathy is well tolerated and will provide an additional 11-43% reduction in albuminuria versus monotherapy. CONCLUSIONS: Dual blockade of the RAS using an ACE inhibitor and an ARB provide statistically significant reductions in albuminuria and blood pressure. Use of dual blockade is safe, but requires additional monitoring for hyperkalemia. Long-term studies are needed to determine whether the decrease in albuminuria will correlate with an actual improvement from overt proteinuria to microalbuminuria or a decreased incidence of end-stage renal disease in the overall diabetic population. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/15187210/Dual_blockade_of_the_renin_angiotensin_system_in_diabetic_nephropathy_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1D598?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -