Blog entry by Soccoh Kabia

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by Soccoh Kabia - Friday, 25 May 2012, 9:38 PM
Anyone in the world

Just as we thought the ONTARGET trial ended all speculation about dual blockade with ACEI and ARB being beneficial, another study reported by a Spanish group showed once again that there is no benefit from dual blockade.

My first impression was why another trial, that is even smaller in numbers than ONTRGET is trying to prove that dual blokade retards the progression of CKD. 
One could accept the rationale that this trial (PRONEDI) is specifically targeting patients with diabetic nephropathy, and that it was probably designed before ONTARGET reported. 
However, notwithstanding the fact that a negative trial is probably driven  by a high prevalence of atherosclerotic renovascular disease on which RAAS inhibition has a deleterious effect, there were a couple of surprising findings.
The first was that there was no difference in BP with single or dual blockade and secondly, there was no difference in proteinuria. Neither the single or the dual blockade group achieved the internationally recommended BP target for DN and the mean BP for both groups was ~140 systolic.  
It is difficult to know what to make out of these data, but I hope that the nephrology community are now convinced that dual blockade is not the holy grail of delaying progression of CKD, and that no more money and effort is spent trying to prove it.
[ Modified: Thursday, 1 January 1970, 1:00 AM ]