To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ACE Inhibitors Plus ARBs Reduce Proteinuria But Increase Kidney Damage URL: http://www.pslgroup.com/dg/228A32.htm Doctor's Guide August 15, 2008
NEW YORK -- August 14, 2008 -- Combination therapy using angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduces the levels of proteinuria more than either therapy alone in patients at high vascular risk but also causes more kidney damage. These are the conclusions of the authors of an article in this week's Cardiology Special Issue of The Lancet. Johannes Mann, MD, McMaster University and Hamilton General Hospital, Hamilton, Ontario, and colleagues performed the ONTARGET study to assess the effects of the ACE inhibitor ramipril and the ARB telmisartan and their combination in patients aged 55 years and older with established vascular disease or diabetes in which organ damage had occurred. The trial took place between 2001 and 2007, and after a 3-week run-in period, 25,620 participants were randomly assigned to ramipril 10 mg daily, telmisartan 80 mg daily, or both combined. The primary endpoint of the trial was composite of the proportions of patients put on kidney dialysis. The secondary outcomes were the number of patients whose levels of serum creatinine doubled or who died, as well as the effect of the treatment on proteinuria. The researchers found that 784 patients had to discontinue treatment due to symptoms of low blood pressure. The number of events for the composite primary outcome was similar for telmisartan and ramipril but increased with combination therapy. Of these events, there were 989 deaths in the telmisartan group compared with 1,014 in the ramipril group and 1,065 in the combination group. For the secondary renal outcomes, dialysis or doubling of serum creatinine, 189 events were recorded in the telmisartan group compared with 174 in the ramipril group and 212 in the combination group. However, the estimated glomerular filtration rate declined more with combination therapy than with either drug alone. Urine protein excretion was least with combination therapy and highest with ramipril. The authors concluded that "in people at high vascular risk, telmisartan's effects on major renal outcomes are similar to [those of] ramipril. Although combination therapy reduces proteinuria to a greater extent than monotherapy, overall it worsens major renal outcomes."
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