Description

Dual RAAS blockade with ACE inhibitors and ARBs provides no additional cardiovascular benefit over either agent alone and significantly increases the risk of hypotension, hyperkalemia, and acute kidney injury.

Mécanisme

Both drugs block angiotensin II effects (ACEi prevents its synthesis; ARB blocks AT1 receptors); combination results in excessive RAAS inhibition, causing additive hypotension, reduced aldosterone (hyperkalemia), and impaired renal autoregulation.

Signification clinique

ONTARGET trial demonstrated no cardiovascular benefit with dual blockade but significantly higher rates of hypotension (4.8%), syncope, diarrhea, renal impairment, and hyperkalemia.

Prise en charge

Avoid dual RAAS blockade in most patients. Exception: select cases of refractory heart failure under specialist supervision with close monitoring of BP, renal function, and potassium.

Avertissement médical

This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.

Data sources: ChEMBL, PubChem, DailyMed.