Table 2.

BP-lowering effect of dual- versus single-class RAS blockadea

SubjectsDesignDual-Class > ARB?Dual-Class > ACEI?
Mogensen et al. (1); n = 199; HTN, type 2 diabetes, microalbuminuriaCandesartan 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 studyYes; 11.2/5.9 mmHg; P = 0.002, 0.003bYes; 8.6/5.6 mmHg; P = 0.02, 0.005b
Jacobsen et al. (2); n = 20; type 1 diabetes, diabetic nephropathyBenazepril 20 mg/d versus valsartan 80 mg/d versus the combination; 8-wk randomized, double-blind, placebo-controlled, crossover trialYes; 7/7 mmHg; P = 0.04, <0.001bNo (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/dEnalapril 40 mg/d plus placebo or irbesartan 300 mg/d 8 wk randomized, double-blind, placebo-controlled, crossover trialN/AYes; 8/4 mmHg; P = 0.002, 0.003b
Stergiou et al. (13); n = 20; HTN, 6 wk benazepril 20 mg/dBenazepril 20 mg/d plus placebo or valsartan 80 mg/d; 5-wk randomized, double-blind, crossover trial; change in 24-h ambulatory BPN/AYes; 6.8/4.9 mmHg; P < 0.01
Agarwal (4) n = 16; HTN, proteinuria, moderate CRFLisinopril 40 mg/d with and without losartan 50 mg/d or placebo; 1-mo randomized, controlled crossover trialN/ANo; 4.6/1.5 mmHg; P = 0.95, 0.59b
Campbell et al. (5); n = 24; HTN, CKDFull-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 trialcNo; −5 mmHgNo; −2 mmHg
Esnault et al. (6); n = 18; proteinuric (>1 g/d), 6 mo ramipril 5 mg/dFull-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 trialNo; 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-analysis14 trials reporting effect of dual versus single RAS blockade on BPYes; 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.