Combination angiotensin-converting enzyme inhibitor and angiotensin receptor blockers: too much of a good thing?

1 Yusuf S Teo KK Pogue J Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358:1547–59.

2 McKelvie RS Yusuf S Pericak D Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999; 100:1056–64.

3 Remuzzi G Benigni A Remuzzi A. Mechanisms of progression and regression of renal lesions of chronic nephropathies and diabetes. J Clin Invest 2006; 116:288–96.

4 Brenner BM Cooper ME de Zeeuw D Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345:861–9.

5 Lewis EJ Hunsicker LG Clarke WR Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345:851–60.

6 Ruggenenti P Perna A Gherardi G Renal function and requirement for dialysis in chronic nephropathy patients on longterm ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet 1998; 352:1252–6.

7 Kunz R Friedrich C Wolbers M Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med 2008; 148:30–48.

8 Ruggenenti P Perna A Remuzzi G. ACE inhibitors to prevent endstage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy. J Am Soc Nephrol 2001; 12:2832–7.