BACKGROUND: We evaluated the renoprotective effects of dual blockade of renin-angiotensin system (RAS) by using a low-dose combination of ACE inhibiter and angiotensin II receptor blocker in type 2 @entity6 @entity1 with advanced @entity8 . The amount of @entity644 and the urinary levels of bioassayable @entity2533 were used as surrogate markers of @entity8 and @entity1463 . METHODS: We performed a prospective double-blinded randomized crossover trial consisting of three 16-week treatment periods with @entity3372 alone (10 mg/day), @entity1564 alone (16 mg/day), and @entity3372 (5 mg/day) plus @entity1564 (8 mg/day) combination therapy. Twenty-one type 2 @entity6 @entity1 with overt @entity8 with a 24 h urinary protein excretion rate (UPER) of > 1.0 g/24 h and @entity1011 clearance (Ccr) of 30 to 59 ml/min/1.73 m2 completed the entire study. RESULTS: Subjects consisted of 10 female and 11 male @entity1 with a mean age of 49 +/- 8 years and duration of @entity6 ranging from 4 to 13 years. At baseline, 24-h blood pressures (BPs) were 133 +/- 6/81 +/- 7 mmHg, Ccr 40.6 +/- 4.1 ml/min/1.73 m2, 24-h UPER 4.1 +/- 1.9 g/24 h, and urinary @entity2533 level 28.4 +/- 16.1 pg/mg @entity1011 (cr). Although there was no comparable change in BP and plasma/urinary biochemical parameters, 24-h UPER was significantly reduced by the combination therapy (2.9 +/- 1.4 g/24 h) compared with that of @entity3372 (3.5 +/- 1.8 g/24 h) and of @entity1564 (3.3 +/- 2.0 g/24 h) single therapy (P < 0.05). Urinary @entity2533 level was reduced in all three therapies compared with that of the control (28.4 +/- 16.1 pg/mg cr) (P < 0.05). However, the combination therapy showed the most significant change (combination 19.6 +/- 10.6 pg/mg cr; @entity3372 24.7 +/- 13.3 pg/mg cr; @entity1564 ; 23.4 +/- 11.7 pg/mg cr). No significant or irreversible adverse effect was observed in the 21 @entity1 who completed the entire study. CONCLUSIONS: The dual blockade of RAS with low-dose @entity3372 plus @entity1564 was found to be safe and offered additive benefits with respect to reducing @entity644 and urinary @entity2533 excretion in @entity6 @entity1 with advanced @entity8 . These benefits were evident as compared with single @entity3372 and @entity1564 therapies at doses two-fold greater. Further study on the dose-titration is mandatory in terms of safety and especially for maximizing renoprotection in this @entity1 population.

Effect of low-dose dual blockade of renin-angiotensin system on urinary @entity2533 in type 2 @entity6 XXXX with advanced @entity8 .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity644 :: ('MESH:D011507', 'Disease') :: ['proteinuria'] @entity8 :: ('MESH:D007674', 'Disease') :: ['nephropathy', 'kidney disease', 'renal injury'] @entity3372 :: ('MESH:D017257', 'Chemical') :: ['ramipril'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetic', 'diabetes'] @entity1564 :: ('MESH:C081643', 'Chemical') :: ['candesartan'] @entity1463 :: ('MESH:D012598', 'Disease') :: ['sclerosis'] @entity2533 :: ('7040', 'Gene') :: ['TGF-beta1'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine']
@entity1 :: (9606,Species) :: ['patients']
