TY - JOUR
T1 - Optimal strategies for preventing progression of renal disease
T2 - Should angiotensin converting enzyme inhibitors and angiotensin receptor blockers be used together?
AU - Komers, Radko
AU - Anderson, Sharon
PY - 2000
Y1 - 2000
N2 - Interruption of the renin-angiotensin system (RAS) with angiotensin converting enzyme (ACE) inhibitors or angiotensin AT1 receptor blockers has been shown to delay progression in a variety of renal diseases, suggesting that the RAS, and its major effector molecule, angiotensin II, are important players in renal pathophysiology. Both antagonists combine inhibition of deleterious effects of angiotensin II with activation of potentially beneficial pathways mediated by nitric oxide and prostaglandins. Some concerns have been raised about the completeness of the RAS blockade achieved by these agents. ACE-independent pathways can generate angiotensin II, whereas increases in angiotensin II levels may compete with the AT1 receptor blocker at the receptor site. It has been suggested that an ACE inhibitor/AT1 receptor blocker combination offers a better therapeutic effect than treatment with either agent alone. In this review, we focus on mechanisms of actions of ACE inhibitors and AT1 receptor blockers, implicate them in the rationale for the use of an ACE inhibitor/AT1 receptor blocker combination, and discuss evidence evaluating the renal effects of the combination as compared to the effects of a single agent. There is a surprising lack of information about the nephroprotective potential of the combination, allowing no consistent conclusions about the superiority of the combination over the single agent. Several experimental and clinical reports suggest that in some conditions, the combination may be beneficial. Rather than providing unequivocal evidence for the use of combination treatment in the renal disease, these studies should be considered as stimuli for more detailed exploration of this issue.
AB - Interruption of the renin-angiotensin system (RAS) with angiotensin converting enzyme (ACE) inhibitors or angiotensin AT1 receptor blockers has been shown to delay progression in a variety of renal diseases, suggesting that the RAS, and its major effector molecule, angiotensin II, are important players in renal pathophysiology. Both antagonists combine inhibition of deleterious effects of angiotensin II with activation of potentially beneficial pathways mediated by nitric oxide and prostaglandins. Some concerns have been raised about the completeness of the RAS blockade achieved by these agents. ACE-independent pathways can generate angiotensin II, whereas increases in angiotensin II levels may compete with the AT1 receptor blocker at the receptor site. It has been suggested that an ACE inhibitor/AT1 receptor blocker combination offers a better therapeutic effect than treatment with either agent alone. In this review, we focus on mechanisms of actions of ACE inhibitors and AT1 receptor blockers, implicate them in the rationale for the use of an ACE inhibitor/AT1 receptor blocker combination, and discuss evidence evaluating the renal effects of the combination as compared to the effects of a single agent. There is a surprising lack of information about the nephroprotective potential of the combination, allowing no consistent conclusions about the superiority of the combination over the single agent. Several experimental and clinical reports suggest that in some conditions, the combination may be beneficial. Rather than providing unequivocal evidence for the use of combination treatment in the renal disease, these studies should be considered as stimuli for more detailed exploration of this issue.
UR - http://www.scopus.com/inward/record.url?scp=0034294906&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034294906&partnerID=8YFLogxK
U2 - 10.1007/s11906-000-0029-8
DO - 10.1007/s11906-000-0029-8
M3 - Article
C2 - 10995522
AN - SCOPUS:0034294906
SN - 1522-6417
VL - 2
SP - 465
EP - 472
JO - Current Hypertension Reports
JF - Current Hypertension Reports
IS - 5
ER -