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How to achieve renal protection in the light of ONTARGET?

Christos Chatzikyrkou1, Jan Menne, Hermann Haller

  • 1Department of Nephrology and Hypertension, Medical School, Hannover, Germany.

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|June 4, 2009
PubMed

Insights

Dual renin-angiotensin system blockade with ACE inhibitors and ARBs offers no additional cardiorenal protection over monotherapy. However, it may benefit selected patients with diabetic nephropathy.

Area of Science:

  • Cardiovascular medicine
  • Nephrology
  • Pharmacology

Background:

  • Renin-angiotensin system (RAS) inhibition using ACE inhibitors (ACEI) or ARBs benefits cardiorenal protection.
  • Combining ACEI and ARBs (dual blockade) is pathophysiologically plausible for enhanced effects.

Purpose of the Study:

  • To evaluate the efficacy and safety of dual RAS blockade compared to monotherapy.

Main Methods:

  • The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study.
  • Compared cardiovascular events and renal outcomes in patients receiving telmisartan alone, ramipril alone, or the combination.

Main Results:

  • Dual blockade did not significantly reduce cardiovascular events or worsen renal outcomes compared to monotherapy.
  • A trend towards better outcomes was observed in patients with existing diabetic nephropathy.

Conclusions:

  • Dual RAS blockade is not recommended as a standard approach for chronic kidney disease management.
  • Combination therapy may be considered for selected patients, particularly those with diabetic nephropathy, but benefits on hard renal endpoints require further investigation.

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