Angiotensin Blockade in Late Autosomal Dominant Polycystic Kidney Disease

This trial tested single versus dual inhibition of the renin–angiotensin–aldosterone system in ADPKD. ACE-inhibitor monotherapy controlled blood pressure in most patients. Adding an angiotensin II–receptor blocker did not alter the decline in estimated GFR. Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the progressive development of kidney cysts. 1 Hypertension develops early in patients with ADPKD and is associated with the progression of disease. 2 The renin–angiotensin–aldosterone system (RAAS) is implicated in the pathogenesis of hypertension in patients with ADPKD. 2 – 7 Angiotensin-converting–enzyme (ACE) inhibitors slow the progression of renal dysfunction in nondiabetic kidney diseases. 8 , 9 On the basis of these data, the use of ACE inhibitors as first-line agents to treat hypertension in patients with ADPKD has become standard clinical practice, although no randomized, clinical trials of sufficient size and quality have shown their superiority . . .