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Dual blockade of the renin-angiotensin-aldosterone system in cardiac and renal disease.
Curr Opin Nephrol Hypertens. 2010 Mar; 19(2):140-52.CO

Abstract

PURPOSE OF REVIEW

Renin-angiotensin-aldosterone system (RAAS) blockade improves outcome in cardiovascular disease (CVD) and chronic kidney disease (CKD), but the residual risk during monotherapy RAAS blockade remains very high. This review discusses the place of dual RAAS blockade in improving these outcomes.

RECENT FINDINGS

The combination of angiotensin-converting enzyme inhibitor (ACEI) with angiotensin II type 1 receptor blocker (ARB) generally had a better antihypertensive and antiproteinuric effect than monotherapy in many studies, but is also associated with more adverse effects. Unfortunately, the effect on hard renal and cardiovascular endpoints is not unequivocal. The combination of ACEI (or ARB) with aldosterone blockade has long-term benefits in heart failure, and an added effect on proteinuria in CKD, but data on hard renal endpoints are lacking. Dual blockade including renin inhibition has added antiproteinuric effects, but studies to gather long-term data are still under way. Available strategies to optimize the effect of monotherapy RAAS blockade include dose titration and correction of volume excess. Whether dual blockade has better efficacy and/or fewer adverse effects than optimized monotherapy has not been investigated.

SUMMARY

Several options are available to increase the effect of monotherapy RAAS blockade. For proteinuric CKD, these can be combined in a stepwise approach aimed at maximal proteinuria reduction; this includes dual blockade for patients with persistent proteinuria during optimized monotherapy RAAS blockade. Long-term randomized studies, however, are needed to support the benefits of dual blockade for long-term renal and cardiovascular outcome in CKD.

Authors+Show Affiliations

Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20051849

Citation

Slagman, Maartje C J., et al. "Dual Blockade of the Renin-angiotensin-aldosterone System in Cardiac and Renal Disease." Current Opinion in Nephrology and Hypertension, vol. 19, no. 2, 2010, pp. 140-52.
Slagman MC, Navis G, Laverman GD. Dual blockade of the renin-angiotensin-aldosterone system in cardiac and renal disease. Curr Opin Nephrol Hypertens. 2010;19(2):140-52.
Slagman, M. C., Navis, G., & Laverman, G. D. (2010). Dual blockade of the renin-angiotensin-aldosterone system in cardiac and renal disease. Current Opinion in Nephrology and Hypertension, 19(2), 140-52. https://doi.org/10.1097/MNH.0b013e3283361887
Slagman MC, Navis G, Laverman GD. Dual Blockade of the Renin-angiotensin-aldosterone System in Cardiac and Renal Disease. Curr Opin Nephrol Hypertens. 2010;19(2):140-52. PubMed PMID: 20051849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual blockade of the renin-angiotensin-aldosterone system in cardiac and renal disease. AU - Slagman,Maartje C J, AU - Navis,Gerjan, AU - Laverman,Gozewijn D, PY - 2010/1/7/entrez PY - 2010/1/7/pubmed PY - 2010/5/1/medline SP - 140 EP - 52 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 19 IS - 2 N2 - PURPOSE OF REVIEW: Renin-angiotensin-aldosterone system (RAAS) blockade improves outcome in cardiovascular disease (CVD) and chronic kidney disease (CKD), but the residual risk during monotherapy RAAS blockade remains very high. This review discusses the place of dual RAAS blockade in improving these outcomes. RECENT FINDINGS: The combination of angiotensin-converting enzyme inhibitor (ACEI) with angiotensin II type 1 receptor blocker (ARB) generally had a better antihypertensive and antiproteinuric effect than monotherapy in many studies, but is also associated with more adverse effects. Unfortunately, the effect on hard renal and cardiovascular endpoints is not unequivocal. The combination of ACEI (or ARB) with aldosterone blockade has long-term benefits in heart failure, and an added effect on proteinuria in CKD, but data on hard renal endpoints are lacking. Dual blockade including renin inhibition has added antiproteinuric effects, but studies to gather long-term data are still under way. Available strategies to optimize the effect of monotherapy RAAS blockade include dose titration and correction of volume excess. Whether dual blockade has better efficacy and/or fewer adverse effects than optimized monotherapy has not been investigated. SUMMARY: Several options are available to increase the effect of monotherapy RAAS blockade. For proteinuric CKD, these can be combined in a stepwise approach aimed at maximal proteinuria reduction; this includes dual blockade for patients with persistent proteinuria during optimized monotherapy RAAS blockade. Long-term randomized studies, however, are needed to support the benefits of dual blockade for long-term renal and cardiovascular outcome in CKD. SN - 1473-6543 UR - https://www.unboundmedicine.com/medline/citation/20051849/Dual_blockade_of_the_renin_angiotensin_aldosterone_system_in_cardiac_and_renal_disease_ L2 - https://doi.org/10.1097/MNH.0b013e3283361887 DB - PRIME DP - Unbound Medicine ER -