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Dual RAS therapy not on target, but fully alive
H J Lambers Heerspink1, D de Zeeuw
1Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. h.j.lambers.heerspink@med.umcg.nl
Nephron. Clinical Practice
|June 3, 2010
Summary
Dual renin-angiotensin system (RAS) blockade for kidney disease, while lowering blood pressure and albuminuria, unexpectedly increased renal risk in the ONTARGET trial, prompting reevaluation of its benefits.
Area of Science:
- Nephrology
- Cardiovascular Pharmacology
Background:
- Renin-angiotensin system (RAS) inhibitors are crucial for managing kidney disease.
- Dual RAS blockade (ACE inhibitor + ARB) showed promise in reducing blood pressure and albuminuria.
Purpose of the Study:
- To review the ONTARGET trial's renal analysis regarding dual-agent RAS therapy.
- To discuss the implications of dual-agent RAS therapy on renal risk and future trial design.
Main Methods:
- Review of the ONTARGET trial design and its renal substudy.
- Analysis of the benefits and risks associated with dual-agent RAS blockade.
Main Results:
- Dual-agent RAS blockade did not delay renal disease progression as expected.
- The ONTARGET renal analysis indicated an increased renal risk with dual-agent RAS therapy.
Conclusions:
- The combination of ACE inhibitors and ARBs in dual-agent RAS blockade may increase renal risk.
- Reevaluation of dual-agent RAS therapy is necessary for patients with nephropathy.
- Findings necessitate revised strategies for future clinical trials in kidney disease management.
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