TOPIC DISCUSSION: EFFECT OF PROTEINURIA on combination treatment

The role of combination blockade has been now come to question at least in the non nephrotic proteinuria world.
But there were some simple questions we wanted answered?
When you have someone on ACEI, and you add an ARB, what additional reduction in proteinuria do you get?
--> It actually is around 25% more reduction or 0.5g/dl additional reduction in proteinuria. This was extensively studied in one paper listed below. In another study, it was around 39% compared to ACEI monotherapy.
What about the effect on GFR?
--->Usually the fall is 4 ml/min
What about the effect on SBP and DBP?
--->Usually fall of 5mm/hg in both with the addition.

http://www.ncbi.nlm.nih.gov/pubmed/17367311
http://www.ncbi.nlm.nih.gov/pubmed/16797382
http://www.ncbi.nlm.nih.gov/pubmed/18468748