Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in combination: theory and practice

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are commonly used to treat hypertension and/or a range of progressive end-organ diseases. The success of each of these drug classes in disease-state management is without dispute, and has led to speculation that given together the observed response would improve upon that observed with a member of each drug class individually given. Few studies are available, however, which carefully address the effect(s) of the combination of an angiotensin-converting enzyme inhibitor and an angiotensin receptor blocker. Review of available studies would seem not to strongly support combination therapy with an angiotensin-converting enzyme inhibitor and an angiotensin receptor blocker as preferred therapy in the broad base of general hypertensive patients with or without end-organ disease. Additional clarifying studies are needed to determine if specific patient subsets exist that might benefit from such combination therapy.