Dual renin-angiotensin system blockade and outcome benefits in XXXX : a narrative review.

@entity1 @entity644 @entity712 @entity101 @entity2316 @entity1163 @entity810 @entity731 @entity551 @entity65 @entity4144 @entity454
PURPOSE OF REVIEW: Inhibition of the renin-angiotensin system (RASi) lowers blood pressure, reduces cardiovascular outcomes and blunts the progressive course of @entity454 . This narrative article summarizes why the hypothesis came up that more complete RASi with two different agents should be more beneficial compared with one agent and how this hypothesis was deflated in randomized clinical trials (RCTs). RECENT FINDINGS: The hypothesis was based on experimental findings and surrogate endpoints in @entity1 , namely lowering of blood pressure and reduction of @entity644 . Three large RCTs in @entity1 with @entity731 or in @entity2316 randomized almost 40000 @entity1 . RASi with one agent was compared with RASi with two agents. All three RCTs ruled out benefits of dual RASi on major cardiovascular outcomes and reported substantial adverse effects of dual RASi. The latter included @entity4144 , @entity810 , symptomatic @entity551 and @entity1163 . There was also no substantial advantage of dual over monotherapy on decline in kidney function. In one RCT, there was a hint of nonsustained, early benefit on kidney outcomes with dual therapy. SUMMARY: Outside @entity712 , RASi with two agents is not indicated to treat @entity101 because of substantial safety concerns and lack of benefit on major @entity65 .
