Makani and colleagues report that dual blockade of the renin–angiotensin–aldosterone system is associated with harm despite previous studies showing that this approach decreases blood pressure and albuminuria. Do these results imply that we should abandon surrogate markers? Or should we become more creative in using them?
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Makani, H., Bangalore, S., Desouza, K. A., Shah, A. & Messerli, F. H. Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. BMJ 346, f360 (2013).
Mann, J. F. et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372, 547–553 (2008).
Messerli, F. H. & Bangalore, S. ALTITUDE trial and dual RAS Blockade: the alluring but soft science of the surrogate end point. Am. J. Med. 126, e1–e3 (2013).
ONTARGET Investigators et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 358, 1547–1559 (2008).
Parving, H. H. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 367, 2204–2213 (2012).
Eijkelkamp, W. B. et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J. Am. Soc. Nephrol. 18, 1540–1546 (2007).
Miao, Y. et al. Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. Diabetologia 54, 44–50 (2011).
Roscioni, S., Miao, Y., De Zeeuw, D. & Lambers Heerspink H. J. High serum potassium levels after losartan can reflect more severe renal disease. Reply to Gonçalves A. R., El Nahas A. M. [letter]. Diabetologia 54, 2965–2967 (2011).
Wilson, P. W. et al. Prediction of coronary heart disease using risk factor categories. Circulation 97, 1837–1847 (1998).
Smink, P. A. et al. A prediction of the renal and cardiovascular efficacy of aliskiren in ALTITUDE using short-term changes in multiple risk markers. Eur. J. Prev. Cardiol. http://dx.doi.org/10.1177/2047487313481754.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
H. J. Lambers Heerspink declares consultancy agreements with the following companies: Abbott, Astellas, Johnson & Johnson, REATA, Takeda, Vitae. D. de Zeeuw declares consultancy agreements with the following companies: Abbott, Astellas, Bristol-Meyers Squibb, Hemocue, Johnson & Johnson, Novartis, Vitae, REATA, Takeda. All payments are directed to their institution.
Rights and permissions
About this article
Cite this article
Heerspink, H., de Zeeuw, D. Dual RAAS blockade has dual effects on outcome. Nat Rev Endocrinol 9, 261–263 (2013). https://doi.org/10.1038/nrendo.2013.65
Published:
Issue date:
DOI: https://doi.org/10.1038/nrendo.2013.65