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Compared with monotherapy (with angiotensin-converting–enzyme [ACE] inhibitors or angiotensin II–receptor blockers [ARBs]), dual blockade of the renin-angiotensin-aldosterone system results in lower blood pressure and less albuminuria. However, results of recent randomized, controlled trials and a meta-analysis indicate that dual blockade doesn't benefit, and might harm, patients.
Three trials involved patients with type 2 diabetes. In one trial, 133 patients with diabetic nephropathy were randomized to receive an ACE inhibitor, an ARB, or dual blockade: After 32 months, the primary endpoint (a composite of >50% increase in serum creatinine, progression to end-stage kidney disease [ESKD], and death) was about 30% in all three groups (NEJM JW…