RT Journal
A1 Mitka M
T1 COnsumer group asks fda to warn patients about hypertension combination therapy
JF JAMA
JO JAMA
YR 2012
FD November 28
VO 308
IS 20
SP 2070
OP 2071
DO 10.1001/jama.2012.25362
UL http://dx.doi.org/10.1001/jama.2012.25362
AB 
At issue are medications containing angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and the direct renin inhibitor aliskiren. Individually, these medications do lower blood pressure, and it was theorized that combining the therapies could confer a synergistic benefit in patients with hypertension and other conditions, such as chronic kidney disease. Indeed, such benefits are seen in many patients given combination therapy often involving a thiazide-type diuretic and another hypertension treatment medication. Combining ACE inhibitors and ARBs has been shown to be effective in reducing proteinuria and reducing cardiovascular death or hospital admissions in patients with chronic heart failure. But otherwise, studies appearing over the past decade not only have shown no benefit to this approach, but also have identified increased risk for adverse events, prompting Public Citizen's petition.