Volume 2, Number 3, September 2001

Inhibition of the renin-angiotensin system, with particular reference to dual blockade treatment
Niels Holmark Andersen, Carl Erik Mogensen

Inhibition of the renin-angiotensin system (RAS) is an essential component in the treatment of both diabetic complications such as hypertension and nephropathy and chronic heart failure.
Angiotensin-converting enzyme inhibitor (ACE-I) treatment does not always provide a satisfactory treatment goal for the individual patient. Either insufficient blood pressure (BP) control or continued microalbuminuria may prevail in spite of high dosage ACE-I.
New studies using dual blockade treatment, combining an ACE-I and an angiotensin II (Ang II) receptor blocker, have shown promising results on both BP and albuminuria. In the CALM study, 199 Type 2 diabetics with microalbuminuria and hypertension were treated with either lisinopril or candesartan or both drugs in combination (dual blockade). The treatment-group taking combination therapy obtained significant BP reduction compared with the other treatment regimens in the follow-up period.
The article presents an overview of the latest trials concerning attenuation of the RAS with special emphasis on the use of dual blockade in hypertension, nephropathy and chronic heart failure.

JRAAS 2001;2:146-152.

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