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ARBs and ACEis together in the treatment of hypertension and its complications? current practical recommendations

Luis M Ruilope1, Julian Segura

  • 1Unidad de Hipertensión, Hospital 12 de Octubre, Av. Córdoba s/n, 28041 Madrid, Spain. ruilope@ad-hocbox.com

Expert Opinion on Pharmacotherapy
|October 28, 2010
PubMed

Insights

Combining angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) offers limited benefits for renin-angiotensin-aldosterone system (RAAS) suppression. Further research is needed to confirm the cardiovascular benefits and safety of combination therapies.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Arterial hypertension is a widespread condition contributing significantly to cardiovascular and renal disease.
  • Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) improve cardiovascular and renal outcomes but have limitations like angiotensin and aldosterone breakthrough.
  • Understanding these limitations is crucial for optimizing antihypertensive therapies.

Purpose of the Study:

  • To review therapeutic strategies for enhancing renin-angiotensin-aldosterone system (RAAS) blockade in hypertension.
  • To evaluate the efficacy and limitations of combining ACEi and ARB therapies.
  • To explore the role of direct renin inhibitors and aldosterone receptor antagonists in dual blockade.

Main Methods:

  • Review of existing literature on RAAS-targeting therapies.
  • Analysis of evidence regarding combination therapy with ACEi and ARB.
  • Discussion of alternative agents like direct renin inhibitors and aldosterone receptor antagonists.

Main Results:

  • Combining ACEi and ARB does not appear to provide the anticipated enhanced suppression of the RAAS or increased clinical benefit.
  • Monotherapy with RAAS suppressors shows cardiovascular benefits but has limitations.
  • Direct renin inhibitors and aldosterone receptor antagonists may enhance the benefits of dual blockade.

Conclusions:

  • While RAAS suppression is beneficial, monotherapy has limitations.
  • Direct renin inhibitors and aldosterone receptor antagonists show promise in augmenting dual blockade strategies.
  • Randomized trials are necessary to validate the cardiovascular benefits and safety of combination therapies.
Abstract

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