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Angiotensin-receptor blockers and ACE inhibitors are known to reduce proteinuria. Combining them might provide greater renoprotection than using either treatment alone, but long-term data to support this theory are lacking.
In a substudy of the randomized, industry-supported ONTARGET trial (JW Cardiol Mar 31 2008), investigators compared the renal effects of the ACE inhibitor ramipril (10 mg daily), the ARB telmisartan (80 mg daily), and their combination in 25,620 patients aged ≥55 with either atherosclerotic vascular disease or diabetes with end-organ damage. The primary outcome for this substudy — the composite of dialysis, doubling of serum creatinine, and death — was a prespecified secondary outcome of the ONTARGET trial, but the study …