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Dual blockade of the renin-angiotensin-aldosterone system: beyond the ACE inhibitor and angiotensin-II receptor blocker combination.
Am J Hypertens. 2009 Oct; 22(10):1032-40.AJ

Abstract

The renin-angiotensin-aldosterone system (RAAS), an important regulator of blood pressure as well as fluid and electrolyte balance, plays an important role in the pathophysiology of cardiovascular and kidney diseases. Blockade of the RAAS with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II (ANG-II) receptor blockers (ARBs) lowers blood pressure, decreases morbidity and mortality in patients with chronic heart failure, and decreases proteinuria and the rate of decline in renal function in patients with chronic kidney disease. Although these drugs are highly effective and are widely used in the management of cardiovascular and kidney diseases, current treatment regimens with ACEIs and ARBs may not completely suppress the RAAS. Combinations of ACEIs and ARBs have been shown to be superior to either agent alone for some, but certainly not all, composite cardiovascular and kidney outcomes. With the growing appreciation of the role of aldosterone in the pathogenesis of cardiorenal diseases and the recent approval of the direct renin inhibitor (DRI), aliskiren, additional combination strategies have emerged that may offer novel ways to more fully suppress the RAAS. This review examines what is presently known about ACEI/ARB combination therapy and explores alternative combination strategies that include DRIs and mineralocorticoid receptor blockers (MRBs).

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York, USA. asb68@columbia.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19661925

Citation

Bomback, Andrew S., and Robert Toto. "Dual Blockade of the Renin-angiotensin-aldosterone System: Beyond the ACE Inhibitor and angiotensin-II Receptor Blocker Combination." American Journal of Hypertension, vol. 22, no. 10, 2009, pp. 1032-40.
Bomback AS, Toto R. Dual blockade of the renin-angiotensin-aldosterone system: beyond the ACE inhibitor and angiotensin-II receptor blocker combination. Am J Hypertens. 2009;22(10):1032-40.
Bomback, A. S., & Toto, R. (2009). Dual blockade of the renin-angiotensin-aldosterone system: beyond the ACE inhibitor and angiotensin-II receptor blocker combination. American Journal of Hypertension, 22(10), 1032-40. https://doi.org/10.1038/ajh.2009.138
Bomback AS, Toto R. Dual Blockade of the Renin-angiotensin-aldosterone System: Beyond the ACE Inhibitor and angiotensin-II Receptor Blocker Combination. Am J Hypertens. 2009;22(10):1032-40. PubMed PMID: 19661925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual blockade of the renin-angiotensin-aldosterone system: beyond the ACE inhibitor and angiotensin-II receptor blocker combination. AU - Bomback,Andrew S, AU - Toto,Robert, Y1 - 2009/08/06/ PY - 2009/8/8/entrez PY - 2009/8/8/pubmed PY - 2010/1/15/medline SP - 1032 EP - 40 JF - American journal of hypertension JO - Am J Hypertens VL - 22 IS - 10 N2 - The renin-angiotensin-aldosterone system (RAAS), an important regulator of blood pressure as well as fluid and electrolyte balance, plays an important role in the pathophysiology of cardiovascular and kidney diseases. Blockade of the RAAS with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II (ANG-II) receptor blockers (ARBs) lowers blood pressure, decreases morbidity and mortality in patients with chronic heart failure, and decreases proteinuria and the rate of decline in renal function in patients with chronic kidney disease. Although these drugs are highly effective and are widely used in the management of cardiovascular and kidney diseases, current treatment regimens with ACEIs and ARBs may not completely suppress the RAAS. Combinations of ACEIs and ARBs have been shown to be superior to either agent alone for some, but certainly not all, composite cardiovascular and kidney outcomes. With the growing appreciation of the role of aldosterone in the pathogenesis of cardiorenal diseases and the recent approval of the direct renin inhibitor (DRI), aliskiren, additional combination strategies have emerged that may offer novel ways to more fully suppress the RAAS. This review examines what is presently known about ACEI/ARB combination therapy and explores alternative combination strategies that include DRIs and mineralocorticoid receptor blockers (MRBs). SN - 1941-7225 UR - https://www.unboundmedicine.com/medline/citation/19661925/Dual_blockade_of_the_renin_angiotensin_aldosterone_system:_beyond_the_ACE_inhibitor_and_angiotensin_II_receptor_blocker_combination_ L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1038/ajh.2009.138 DB - PRIME DP - Unbound Medicine ER -