Emerging drug combinations to optimize renovascular protection and blood pressure goals Full Text
International Journal of Nephrology and Renovascular Disease, 04/05/2012
Clinical Article
Escobar C et al. – Renin–angiotensin system inhibitors recommended in this context are angiotensin–converting enzyme inhibitors and angiotensin receptor blockers. Aliskiren, the first oral direct renin inhibitor available, has shown promising results.
- Hypertension and renal disease are closely related.
- In fact, there is an inverse linear relationship between renal function and prevalence of hypertension.
- Hypertensive patients with renal dysfunction exhibit a poor clinical profile, which markedly increases their risk for cardiovascular outcomes.
- This review considers the available evidence on the best therapeutic approach for optimizing renovascular protection in the hypertensive population.
- To effectively reduce or at least slow the establishment and progression of renal disease in the hypertensive population it is critical to reach blood pressure targets.
- Many studies have shown that angiotensin–converting enzyme inhibitors and angiotensin receptor blockers prevent or at least delay the development of microalbuminuria in patients with hypertension and type 2 diabetes, reduce the incidence of overt diabetic nephropathy, and are also beneficial in patients with nondiabetic renal disease.
- Therefore, renin–angiotensin system (RAS) inhibition plays a key role in the prevention of renal outcomes.
- As the majority of patients with hypertension will need at least two antihypertensive agents to achieve blood pressure goals, the use of RAS inhibitors is a mandatory part of antihypertensive therapy.
- The question of which antihypertensive agent is the best choice for combining with RAS blockers should be considered.
- Many studies have shown that diuretics and calcium channel blockers are the best choice.
- However, more studies are needed to clarify the subgroups of patients who will benefit more from a combination with a diuretic or from a combination with a calcium channel blocker.
