The renin-angiotensin system is involved in the progression of chronic renal disease of both diabetic and nondiabetic
origin. The angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have been demonstrated to reduce
urinary protein excretion and attenuate the development of renal injury. This prospective, randomized, 12-month
study assessed the effects of ramipril (N=23) vs. valsartan (N=22) vs. combination of ramipril and valsartan (N=26) on
proteinuria, renal function and metabolic profile in 71 patients with nondiabetic proteinuria with normal or slightly impaired
renal function. Monotherapy with ramipril or valsartan and combination of these two drugs significantly reduced
proteinuria, serum creatinine, cholesterol and triglycerides as well as systolic and diastolic arterial blood pressure.
There was no significant difference among three study groups according to reduction of arterial blood pressure,
serum cholesterol and triglycerides. At one year, a significant reduction in serum creatinine was recorded in all three
study groups, whereas at 3 and 6 months a statistically significant reduction in serum creatinine was only observed in
patients on combination therapy. In addition, at 3 months the reduction of proteinuria was significantly greater in patients
on combination therapy than in those on either monotherapy. These results indicated the combination therapy with
angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to be more efficacious than either monotherapy
in reducing proteinuria and serum creatinine level in the first 3 (proteinuria and serum creatinine) or 6 (serum
creatinine) months of treatment
