Optimal strategies for preventing progression of renal disease: Should angiotensin converting enzyme inhibitors and angiotensin receptor blockers be used together?

被引:1
|
作者
Komers R. [1 ]
Anderson S. [1 ]
机构
[1] Division of Nephrology and Hypertension, Oregon Health Sciences University, Portland, OR 97201-2940, PP262
关键词
Angiotensin; Angiotensin Converting Enzyme; Enalapril; Losartan; Receptor Blocker;
D O I
10.1007/s11906-000-0029-8
中图分类号
学科分类号
摘要
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. Copyright © 2000 by Current Science Inc.
引用
收藏
页码:465 / 472
页数:7
相关论文
共 50 条
  • [1] Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Treatment of Hypertension: Should they be Used Together?
    Verdecchia, Paolo
    Angeli, Fabio
    Mazzotta, Giovanni
    Ambrosio, Giuseppe
    Reboldi, Gianpaolo
    CURRENT VASCULAR PHARMACOLOGY, 2010, 8 (06) : 742 - 746
  • [2] Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease
    Natale, Patrizia
    Palmer, Suetonia C.
    Navaneethan, Sankar D.
    Craig, Jonathan C.
    Strippoli, Giovanni F. M.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2024, (04):
  • [3] Role of Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in the prevention of progression of renal disease
    Ram C.V.S.
    Vergne-Marini P.
    Current Hypertension Reports, 1999, 1 (5) : 431 - 435
  • [4] Angiotensin converting enzyme inhibitors and angiotensin receptor blockers
    Shrimpton, A. J.
    Walker, S. L. M.
    Ackland, G. L.
    BJA EDUCATION, 2020, 20 (11) : 362 - 367
  • [5] Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?
    Ahmed, Aimun
    Jorna, Tom
    Bhandari, Sunil
    NEPHRON, 2016, 133 (03) : 147 - 158
  • [6] ANGIOTENSIN CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR ANTAGONISTS FOR PREVENTING THE PROGRESSION OF DIABETIC KIDNEY DISEASE
    Natale, P.
    Palmer, S.
    Ruospo, M.
    Craig, J.
    Tonelli, M.
    Strippoli, G.
    NEPHROLOGY, 2021, 26 : 48 - 48
  • [7] Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease
    Strippoli, G. F. M.
    Bonifati, C.
    Craig, M.
    Navaneethan, S. D.
    Craig, J. C.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2006, (04):
  • [8] Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in hypertension
    Ritter, J. M.
    BMJ-BRITISH MEDICAL JOURNAL, 2011, 342
  • [9] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic renal disease: Safety issues
    Mangrum, AJ
    Bakris, GL
    SEMINARS IN NEPHROLOGY, 2004, 24 (02) : 168 - 175
  • [10] Discontinuation of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Chronic Kidney Disease
    Qiao, Yao
    Shin, Jung-Im
    Sang, Yingying
    Inker, Lesley A.
    Secora, Alex
    Luo, Shengyuan
    Coresh, Josef
    Alexander, G. Caleb
    Jackson, John W.
    Chang, Alex R.
    Grams, Morgan E.
    MAYO CLINIC PROCEEDINGS, 2019, 94 (11) : 2220 - 2229