Dual Blockade of the Renin-Angiotensin System Doesn't Prevent Mortality

The combination of an angiotensin-converting–enzyme (ACE) inhibitor plus an angiotensin-receptor blocker (ARB) sometimes is prescribed to patients with heart failure, hypertension, or diabetes, despite limited evidence of efficacy and lukewarm or no support from clinical guidelines. In this meta-analysis of 33 randomized controlled trials (mean duration, 52 weeks), investigators compared the outcomes of dual blockade with those of monotherapy in >68,000 patients (mean age, 61; 71% men).

Dual blockade consisted of an ACE inhibitor plus an ARB in 22 trials; the other trials included various combinations of an ACE inhibitor or an ARB with aliskiren (Tekturna). Compared with monotherapy, dual therapy did not prevent all-cause mortality or cardio…