Table 2.

BP-lowering effect of dual- versus single-class RAS blockade^a

Subjects	Design	Dual-Class > ARB?	Dual-Class > ACEI?
Mogensen et al. (1); n = 199; HTN, type 2 diabetes, microalbuminuria	Candesartan 16 mg/d versus lisinopril 20 mg/d versus the combination; 12-wk monotherapy, then 12-wk monotherapy or combination therapy; prospective, randomized, parallel group, double-blind study	Yes; 11.2/5.9 mmHg; P = 0.002, 0.003^b	Yes; 8.6/5.6 mmHg; P = 0.02, 0.005^b
Jacobsen et al. (2); n = 20; type 1 diabetes, diabetic nephropathy	Benazepril 20 mg/d versus valsartan 80 mg/d versus the combination; 8-wk randomized, double-blind, placebo-controlled, crossover trial	Yes; 7/7 mmHg; P = 0.04, <0.001^b	No (SBP); P = 0.06Yes (DBP); P < 0.0016/7 mmHg
Jacobsen et al. (3); n = 24; type 1 diabetes, diabetic nephropathy, >3 mo enalapril 40 mg/d	Enalapril 40 mg/d plus placebo or irbesartan 300 mg/d 8 wk randomized, double-blind, placebo-controlled, crossover trial	N/A	Yes; 8/4 mmHg; P = 0.002, 0.003^b
Stergiou et al. (13); n = 20; HTN, 6 wk benazepril 20 mg/d	Benazepril 20 mg/d plus placebo or valsartan 80 mg/d; 5-wk randomized, double-blind, crossover trial; change in 24-h ambulatory BP	N/A	Yes; 6.8/4.9 mmHg; P < 0.01
Agarwal (4) n = 16; HTN, proteinuria, moderate CRF	Lisinopril 40 mg/d with and without losartan 50 mg/d or placebo; 1-mo randomized, controlled crossover trial	N/A	No; 4.6/1.5 mmHg; P = 0.95, 0.59^b
Campbell et al. (5); n = 24; HTN, CKD	Full-dosage monotherapy (benazepril 20 mg/d, valsartan 160 mg/d) versus half-dosage combination therapy (benazepril 10 mg/d, valsartan 80 mg/d); 8-wk randomized, prospective, open-label, crossover trial^c	No; −5 mmHg	No; −2 mmHg
Esnault et al. (6); n = 18; proteinuric (>1 g/d), 6 mo ramipril 5 mg/d	Full-dosage monotherapy (ramipril 10 mg/d, valsartan 160 mg/d) versus half-dosage combination therapy (ramipril 5 mg/d, valsartan 80 mg/d); 4-wk randomized, prospective, open-label, crossover trial	No; 144.12 ± 26.5/77.65 ± 13.5 mmHg (ACEI/ARB) versus 148.88 ± 26.5/81.25 ± 13.4 mmHg (ARB)	No; 144.12 ± 26.5/77.65 ± 13.5 (ACEI/ARB) versus 142.44 ± 30.0/78.94 ± 14.4 mmHg (ACEI)
Doulton et al. (7); meta-analysis	14 trials reporting effect of dual versus single RAS blockade on BP	Yes; 3.8/2.9 mmHg (95% CI 2.4 to 5.3/0.4 to 5.4 mmHg)	Yes; 4.7/3.0 mmHg (95% CI 2.9 to 6.5/1.6 to 4.3 mmHg)

↵^a Length of treatment in crossover studies refers to time on each therapy rather than total study length. DBP, diastolic BP; SBP, systolic BP.
↵^b The two P values refer to SBP and DBP, respectively.
↵^c Goal was comparable BP control in single- and dual-class RAS blockade.