The SUPPORT trial evaluated the effect of adding the angiotensin-receptor blocker olmesartan to a combination of angiotensin-converting-enzyme inhibitors and β-blockers in hypertensive patients with chronic stable heart failure. Unfortunately, this triple renin–angiotensin–aldosterone system blockade was associated with worsening of renal function and increases in cardiac events and mortality.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Sakata, Y. et al. Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial. Eur. Heart J. http://dx.doi.org/10.1093/eurheartj/ehu504.
Sevá Pessôa, B. et al. Key developments in renin–angiotensin–aldosterone system inhibition. Nat. Rev. Nephrol. 9, 26–36 (2013).
Balcarek, J. et al. Multiple ascending dose study with the new renin inhibitor VTP-27999: nephrocentric consequences of too much renin inhibition. Hypertension. 63, 942–950 (2014).
Nussberger, J. & Bohlender, J. Pharmacotherapy: Optimal blockade of the renin-angiotensin-aldosterone system. Nat. Rev. Cardiol. 10, 183–184 (2013).
Packer, M. Why do the kidneys release renin in patients with congestive heart failure? A nephrocentric view of converting-enzyme inhibition. Am. J. Cardiol. 60, 179–184 (1987).
Schilders, J. E., Wu, H., Boomsma, F., van den Meiracker, A. H. & Danser, A. H. J. Renin-angiotensin system phenotyping as a guidance toward personalized medicine for ACE inhibitors: can the response to ACE inhibition be predicted on the basis of plasma renin or ACE? Cardiovasc. Drugs Ther. 28, 335–345 (2014).
ONTARGET Investigators et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 358, 1547–1559 (2008).
Fried, L. F. et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N. Engl. J. Med. 369, 1892–1903 (2013).
de Zeeuw, D. The end of dual therapy with renin–angiotensin–aldosterone system blockade? N. Engl. J. Med. 369, 1960–1962 (2013).
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).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
PowerPoint slides
Rights and permissions
About this article
Cite this article
Danser, A., van den Meiracker, A. New data do not SUPPORT triple RAAS blockade. Nat Rev Nephrol 11, 260–262 (2015). https://doi.org/10.1038/nrneph.2015.30
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2015.30
This article is cited by
-
Mineralocorticoid Antagonism and Diabetic Kidney Disease
Current Diabetes Reports (2019)
