when to use ACEI AND ARB together??

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when to use ACEI AND ARB together?? any study to back this up??? THANKS

 

[njac]

in CHF... a quick google provided http://www.cardiology.utmb.edu/slides/sec-5-invasive/ACE%20and%20ARB%20in%20heart%20failure.pdf and the Val-HEFT and CHARM-added studies were with both ACE and ARB. It's a nice powerpoint lecture overall

 

[Farmercyst]

In Pharmaceutical Chem they brought up its use in Chronic renal failure. I googled "ACE and ARB in renal failure" and this was the first link.
http://www.medscape.com/viewarticle/571460

 

[rxforlife2004]

I personally don't think that using both ACE + ARB will do much better, yet even worsening electrolyte (esp K) and renal function. There are so many options out there. Why trying this odd? Usually, i would discuss with MD when seeing such combination and this is the answer "yeah...go ahead and d/c one for me, thanks".

 

[Allure]

There are a lot of studies out there to see if ACEIs + ARBs would be better than either agent alone and there are a lot of contradicting results. A few studies show that combine the two don't increase the benefits, but it increases the ADRs. But there are studies that show either ACEIs or ARBs with Aliskiren (a new agent) seem to work better, but it's too early to tell. I'll try to find those articles again once I'm back to school next week.

 

[Jbuprepharm]

The Steno Institute in Denmark found, in a preliminary study, that using a maximal dose of an ACEI and ARB together helped to reduce albuminuria in diabetic patients with HTN. I don't have the article handy, but if you really want it I can find it.

So, in other words, this would be another instance where one COULD, even if it is not optimal therapy

 

[UTPharm]

I dont know why you would use both an ACEI and an ARB, in general cases. THey both block the same PATHWAY. would it even be cost benificial?

Can someone explain to me more specifically? like in CHF.

 

[SpirivaSunrise]

I dont know why you would use both an ACEI and an ARB, in general cases. THey both block the same PATHWAY. would it even be cost benificial?

Can someone explain to me more specifically? like in CHF.

Like njac mentioned, pull up the CHARM/CHARM-Added studies (Val-HeFT is another, and ONTARGET will be the next big one), and look at effect on hospitalizations and mortality. Also, look into a term called "ACE escape" (where inhibition of angiotensin production wears off over time). The theory isn't completely understood, but you'll see that the concept of ARB + ACEI combo is to block the cascade via two receptors in the pathway...

 

[UTPharm]

Hey thanks.... and somehow I am a senior member now....

Like njac mentioned, pull up the CHARM/CHARM-Added studies (Val-HeFT is another, and ONTARGET will be the next big one), and look at effect on hospitalizations and mortality. Also, look into a term called "ACE escape" (where inhibition of angiotensin production wears off over time). The theory isn't completely understood, but you'll see that the concept of ARB + ACEI combo is to block the cascade via two receptors in the pathway...

 

[spacecowgirl]

The ONTARGET study doesn't look so good for the ACE/ARB combo.

 

[Tamiya]

Over here in Malaysia, I've had the opportunity of using ACEI+ARBs in CCF cases where the patient's BP would not come down, despite being on many other antihypertensives. I use it personally as a last ditch effort, but I've generally seen it work well with little deterioration in the patient's kidney function.