Have we fallen off target with concerns surrounding dual RAAS blockade?

Abstract

A misinterpretation of the results from ONTARGET (Ongoing Telmisartan alone and in combination with ramipril Global Endpoint Trial) has sparked both efficacy and safety concerns within the nephrology community regarding the utilization of dual RAAS blockade to achieve more desirable renal outcomes. Two important considerations are requisite prior to interpreting these results, specifically: the context of the cohort studied (non-proteinuric CKD patients at low risk of progression) and the inadequate power of the study to assess renal outcomes. The cardiac and renal protection afforded from dual RAAS blockade in select populations, particularly proteinuric CKD and CHF, is supported by literature. Moreover, the response to dual RAAS blockade involving different combinations of ACE inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors, may not be uniform amongst all patient populations. Will we continue to withhold the appropriate medical therapy from certain individuals based on misconstrued data? The proceedings provide a critical analysis of the ONTARGET study and an evidence-based substantiation for the utilization of various forms of dual RAAS blockade in proteinuric kidney disease and beyond.