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Review
. 2014 Sep;23(5):449-55.
doi: 10.1097/MNH.0000000000000043.

Complete inhibition of the renin-angiotensin-aldosterone system; where do we stand?

Shan Shan Chen  1 , Stephen L Seliger, Linda F Fried
Affiliations
Review

Complete inhibition of the renin-angiotensin-aldosterone system; where do we stand?

Shan Shan Chen et al. Curr Opin Nephrol Hypertens. 2014 Sep.

Abstract

Purpose of review: This review presents the role of combination therapy of renin-angiotensin-aldosterone system blockade on cardiovascular and kidney disease.

Recent findings: Three large randomized controlled trials comparing combination therapy of renin-angiotensin-aldosterone system blockade to monotherapy in individuals with increased cardiovascular risk, chronic kidney disease, or diabetic nephropathy have been reported. These trials - ONTARGET, ALTITUDE, and VA NEPHRON-D - demonstrated an excess risk of adverse effects [especially acute kidney injury (AKI) and hyperkalemia] with combination therapy, without significant benefit in reducing cardiovascular and renal morbidity.

Summary: Current evidence supports avoiding dual renin-angiotensin-aldosterone system blockade in patients with chronic kidney disease. Subsequent studies of dual renin-angiotensin-aldosterone system blockade should examine adverse event risks and renal progression endpoints.

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