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See Latest ArticlesBlocking the renin-angiotensin system: dual- versus mono-therapy
Expert Review of Cardiovascular Therapy , 06/12/09
Ravandi A et al. – A review of dual- vs mono-therapy for renin–angiotensin system (RAS) blockade reports that determination of whether dual therapy is beneficial in pts with diabetic renal failure is pending further study. Overall, pts receiving dual therapy, if clinically justified, must be monitored closely for potential adverse effects.
Methods- Review of dual- vs mono-therapy for RAS blockade
- Summary of Valsartan in Acute Myocardial Infarction Trial (VALIANT), Ongoing Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events (ONTARGET), Candesartan in Heart Failure (CHARM), and Valsartan Heart Failure Trial (Val-HeFT) trials
- Target-organ damage is an effect of activated RAS partly due to hypertension
- Blocking angiotensin-converting enzyme (ACE) attenuates RAS pathologic effects
- ACE inhibition improves outcomes in prevention of acute myocardial infarction, lowering morbidity/mortality in congestive heart failure, and attenuates renal dysfunction
- Angiotensin receptor blockers (ARBs) have similar efficacy to ACE inhibitors in reducing cardiovascular outcomes
- Better overall inhibition of RAS by dual therapy may improve clinical outcomes
- Combination therapy is beneficial in congestive heart failure or renal disease
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