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Combined Treatment With Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Review of the Current Evidence

Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece

Evagelos N. Liberopoulos, MD

Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital and University College Medical School, London, United Kingdom

Dimitrios N. Kiortsis, MD

Laboratory of Physiology, School of Medicine, University of Ioannina, Ioannina, Greece.

Dimitri P. Mikhailidis, MD

Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital and University College Medical School, London, United Kingdom

Moses S. Elisaf, MD

Department of Internal Medicine, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; egepi{at}cc.uoi.gr

Several studies have shown that angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are useful in the treatment of hypertension, cardiovascular disease, chronic heart failure, and some types of nephropathy. In this context, dual renin-angiotensin system blockade with both angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers may be more effective than treatment with each agent alone. Many clinical trials have demonstrated the beneficial effect of this combined treatment on proteinuria, hypertension, heart failure, and cardiovascular events. Moreover, these studies demonstrated that dual renin-angiotensin system blockade is generally safe and well tolerated. Long-term studies are under way to confirm these effects and also investigate the effectiveness of dual reninangiotensin system blockade on cerebrovascular disease and prevention of type 2 diabetes mellitus. These studies are expected to define the optimal use of combination treatment in everyday clinical practice. This review considers the most important clinical trials that evaluated the effect of dual renin-angiotensin system blockade on blood pressure, heart failure, and renal function.

Key Words: angiotensin-converting enzyme inhibitors • angiotensin II receptor blockers • dual renin-angiotensin system blockade • myocardial infarction • heart failure • renal failure

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