ACE Inhibitor-Angiotensin Receptor Blocker Combinations: A Clinicians Perspective

T.   W.R.   Doulton

Abstract

ACE Inhibitors (ACEI) and angiotensin receptor blockers (ARB) inhibit the renin-angiotensin system, but ACEI may do so incompletely when administered as monotherapy at conventional doses. In theory, combining an ACEI and ARB might be beneficial, whereas clinical evidence for this approach in hypertension is lacking. An ACEI-ARB combination is likely to be useful in proteinuric renal disease, but recent experimental evidence suggests that very high dose monotherapy with an ARB may be the best approach. However, the results of large outcome studies for combinations vs. ACEI or ARB monotherapy are still awaited.

Keywords: Renin-angiotensin system, angiotensin converting enzyme (ACE) inhibitor, angiotensin-receptor blocker, hypertension, diabetic nephropathy, chronic kidney disease, proteinuria