Double blockade of renin-angiotensin-aldosteron system – is it always beneficial? Review article
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Abstract
The wide indication spectrum for the angiotensin II converting enzyme inhibitors in the high risk patients therapy suggests that more selective blockers of angiotensin II (angiotensin II AT1 receptor blockers) will have similar if not better action profile. Because of those facts the interest in dual blockade of the RAS arises. It is thought that this may help to avoid the ACEI escape phenomenon. In this paper the potential benefits and indication for dual RAS blockade are revised.
Up till now there are no big clinical trials comparing the efficacy of dual blockade (ACEI + ARB) with other drug classes in hypertensive patients. In existing trials with nephropathy or heart failure patients the dual blockade was connected with lower blood pressure achieved. This finding may suggest lower complication risk that may be achieved with prescribing ACEI with ARB in hypertensive patients.
In congestive heart failure patients it have been observed that administrating dual blockade of RAS was connected with lower rates of combined endpoint of cardiovascular mortality and hospitalization rate. The improvement in quality of life was also observed. It is also noteworthy that this kind of therapy has higher adverse event rate (high potassium level).
Among patients with nephropathy receiving dual RAS blockade two fold decrease in incidence of primary end point (doubling of serum creatinine level or progression to ESRD) has been observed. This results were achieved independently of basic levels of proteinuria and nephropathy etiology.
To sum up it is thought that dual blockade of the RAA system in pre specified groups of patients may have a substantially beneficial clinical effect.
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