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Dual blockade of the renin-angiotensin system in the progression of renal disease: the need for more clinical trials.
J Am Soc Nephrol. 2006 Dec; 17(12 Suppl 3):S250-4.JA

Abstract

There is clear evidence that pharmacologic blockade of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) reduces proteinuria and slows the progression of renal disease in diabetic and nondiabetic nephropathies, a beneficial effect that is not related to BP control. Some patients exhibit a significant beneficial response, whereas others do not. The absence of response may be explained by the incomplete blockade of the RAS obtained with ACEI. In the search of new alternatives that could improve the antiproteinuric and nephroprotective effects of RAS blockers, the association of ACEI and ARB might prove useful. ARB produces a complete blockade of the RAS. Several studies have shown a more marked antiproteinuric effect of the dual blockade of the RAS versus ACEI or ARB alone. A recent study also demonstrated that this more marked antiproteinuric effect is associated with less progression of renal disease in primary nondiabetic nephropathies despite a similar effect on BP. Until now, there has not been any reference to a beneficial effect on progression of the dual blockade in type 2 diabetic nephropathy, which is the most frequent cause of ESRD. A multicenter, prospective, open, active-controlled, and parallel-group trial was designed to compare the effects of an ACE inhibitor versus an ARB or its combination on renal disease progression, proteinuria, and cardiovascular events in type 2 diabetic nephropathy.

Authors+Show Affiliations

Department of Nephrology, Fundacion Hospital Alcorcon, C/Budapest 1 Alcorcon, Madrid 28922, Spain. gmfernandez@fhalcorcon.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17130270

Citation

Fernandez-Juárez, Gema, et al. "Dual Blockade of the Renin-angiotensin System in the Progression of Renal Disease: the Need for More Clinical Trials." Journal of the American Society of Nephrology : JASN, vol. 17, no. 12 Suppl 3, 2006, pp. S250-4.
Fernandez-Juárez G, Barrio V, de Vinuesa SG, et al. Dual blockade of the renin-angiotensin system in the progression of renal disease: the need for more clinical trials. J Am Soc Nephrol. 2006;17(12 Suppl 3):S250-4.
Fernandez-Juárez, G., Barrio, V., de Vinuesa, S. G., Goicoechea, M., Praga, M., & Luño, J. (2006). Dual blockade of the renin-angiotensin system in the progression of renal disease: the need for more clinical trials. Journal of the American Society of Nephrology : JASN, 17(12 Suppl 3), S250-4.
Fernandez-Juárez G, et al. Dual Blockade of the Renin-angiotensin System in the Progression of Renal Disease: the Need for More Clinical Trials. J Am Soc Nephrol. 2006;17(12 Suppl 3):S250-4. PubMed PMID: 17130270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual blockade of the renin-angiotensin system in the progression of renal disease: the need for more clinical trials. AU - Fernandez-Juárez,Gema, AU - Barrio,Vicente, AU - de Vinuesa,Soledad García, AU - Goicoechea,Marian, AU - Praga,Manuel, AU - Luño,José, PY - 2006/11/30/pubmed PY - 2007/12/12/medline PY - 2006/11/30/entrez SP - S250 EP - 4 JF - Journal of the American Society of Nephrology : JASN JO - J Am Soc Nephrol VL - 17 IS - 12 Suppl 3 N2 - There is clear evidence that pharmacologic blockade of the renin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) reduces proteinuria and slows the progression of renal disease in diabetic and nondiabetic nephropathies, a beneficial effect that is not related to BP control. Some patients exhibit a significant beneficial response, whereas others do not. The absence of response may be explained by the incomplete blockade of the RAS obtained with ACEI. In the search of new alternatives that could improve the antiproteinuric and nephroprotective effects of RAS blockers, the association of ACEI and ARB might prove useful. ARB produces a complete blockade of the RAS. Several studies have shown a more marked antiproteinuric effect of the dual blockade of the RAS versus ACEI or ARB alone. A recent study also demonstrated that this more marked antiproteinuric effect is associated with less progression of renal disease in primary nondiabetic nephropathies despite a similar effect on BP. Until now, there has not been any reference to a beneficial effect on progression of the dual blockade in type 2 diabetic nephropathy, which is the most frequent cause of ESRD. A multicenter, prospective, open, active-controlled, and parallel-group trial was designed to compare the effects of an ACE inhibitor versus an ARB or its combination on renal disease progression, proteinuria, and cardiovascular events in type 2 diabetic nephropathy. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/17130270/Dual_blockade_of_the_renin_angiotensin_system_in_the_progression_of_renal_disease:_the_need_for_more_clinical_trials_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=17130270 DB - PRIME DP - Unbound Medicine ER -