A clinical evaluation on the combination therapy with ACE-I and ARB, and with ARB and CCB in patients with progressive chronic renal diseases

摘要

Due to therapy resistant hypertension, combination antihypertensive therapy is indispensable for retarding the progression of chronic renal diseases. The majority of pilot studies investigating the renoprotective effect of ACE-I plus ARB revealed a better anti-proteinuric effect of this combination than either of the monotherapies for patients with either diabetic or non-diabetic renal diseases. In contrast, the effect of combination therapy with ACE-I/ARB plus CCB in protecting the kidney from hypertension appeared to be still a matter of controversy. Although the combined therapy with ACE-I plus ARB is superior to that with CCB plus ARB to achieve a greater reduction in urinary protein excretion than either of the monotherapies, one must be aware of the potential hazards associated with the former combined therapy such as worsening of renal anemia and hyperkalemia, especially in patients with impaired renal function. Whether add-on ARB to ACE-I or CCB causes antiproteinuric effects or long-term renoprotection requires larger and longer prospective, randomized controlled trials in the future.