Is There Added Value to Adding ARB to ACE Inhibitors in the Management of CKD?

被引：18

作者：

Cohen, Debbie L. ^{[1
]}

Townsend, Raymond R. ^{[1
]}

机构：

[1] Univ Penn, Renal Electrolyte & Hypertens Div, Dept Med, Philadelphia, PA 19104 USA

来源：

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2009年 / 20卷 / 08期

关键词：

CONVERTING-ENZYME-INHIBITOR; ANGIOTENSIN RECEPTOR BLOCKER; NONDIABETIC RENAL-DISEASE; COMBINATION THERAPY; DIABETIC-NEPHROPATHY; LOSARTAN; METAANALYSIS; COOPERATE; EFFICACY; SYSTEM;

D O I：

10.1681/ASN.2008040381

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Antagonism of the rennin-angiotensin-aldosterone-system (RAAS) decreases BP and reduces proteinuria in chronic kidney disease. BP is decreased approximately 5 mmHg when angiotensin II blockers are added to angiotensin-converting enzyme (ACE) inhibitors and is less than typically seen when other agents are added to existing ACE inhibitor regimens. Dual RAAS blockade results in additional reduction in proteinuria. Clinically insignificant increases in hyperkalemia and modest decreases in GFR occur. Data regarding long-term preservation of renal function are lacking. We suggest dual RAAS blockade be used in patients with chronic kidney disease with residual proteinuria on maximal ACE inhibitor or angiotensin II blocker therapy, anticipating additional data with ongoing trials.

引用

页码：1666 / 1668

页数：3

共 16 条

[1]

Bidani A, 2006, AM J NEPHROL, V26, P632

[2] ANTIHYPERTENSIVE THERAPY WITH MK-421 - ANGIOTENSIN-II-RENIN RELATIONSHIPS TO EVALUATE EFFICACY OF CONVERTING ENZYME BLOCKADE [J].

BIOLLAZ, J ;

BRUNNER, HR ;

GAVRAS, I ;

WAEBER, B ;

GAVRAS, H .

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 1982, 4 (06) :966-972

[3] Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [J].

Brenner, BM ;

Cooper, ME ;

de Zeeuw, D ;

Keane, WF ;

Mitch, WE ;

Parving, HH ;

Remuzzi, G ;

Snapinn, SM ;

Zhang, ZX ;

Shahinfar, S .

NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :861-869

[4]

*CONSENSUS TRIAL S, 1987, CLIN NEPHROL, V316, P1429

[5] THE ANTIPROTEINURIC EFFECT OF ACE-INHIBITION MEDIATED BY INTERFERENCE IN THE RENIN-ANGIOTENSIN SYSTEM [J].

GANSEVOORT, RT ;

DEZEEUW, D ;

DEJONG, PE .

KIDNEY INTERNATIONAL, 1994, 45 (03) :861-867

[6] Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta-analysis [J].

Jennings, D. L. ;

Kalus, J. S. ;

Coleman, C. I. ;

Manierski, C. ;

Yee, J. .

DIABETIC MEDICINE, 2007, 24 (05) :486-493

[7] Meta-analysis: Effect of monotherapy and combination therapy with inhibitors of the renin-angiotensin system on proteinuria in renal disease [J].

Kunz, Regina ;

Friedrich, Chris ;

Wolbers, Marcel ;

Mann, Johannes F. E. .

ANNALS OF INTERNAL MEDICINE, 2008, 148 (01) :30-48

[8] Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes [J].

Lewis, EJ ;

Hunsicker, LG ;

Clarke, WR ;

Berl, T ;

Pohl, MA ;

Lewis, JB ;

Ritz, E ;

Atkins, RC ;

Rohde, R ;

Raz, I .

NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (12) :851-860

[9] THE EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION ON DIABETIC NEPHROPATHY [J].

LEWIS, EJ ;

HUNSICKER, LG ;

BAIN, RP ;

ROHDE, RD .

NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (20) :1456-1462

[10] Combination therapy with an angiotensin receptor blocker and an ACE inhibitor in proteinuric renal disease: A systematic review of the efficacy and safety data [J].

MacKinnon, Martin ;

Shurraw, Sabin ;

Akbari, Ayub ;

Knoll, Greg A. ;

Jaffey, James ;

Clark, Heather D. .

AMERICAN JOURNAL OF KIDNEY DISEASES, 2006, 48 (01) :8-20

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