Table 1

Characteristics of the Included Trials

Trial/First Author (Ref. #), YearPatient PopulationTotal PatientsMean Age (yrs)Follow-Up (Weeks)Comparison GroupDual RAS Blockers
RAS Blocker Monotherapy
Reduction in BP With Dual RAS Blockers Compared With MonotherapyRisk of Bias
ALTITUDE (1) 2012Diabetic nephropathy8,56165139Aliskiren+ACEi or ARB vs. ACEi or ARB alone137.3/74.1137.3/74.3−1.3 mm Hg systolic
−0.6 mm Hg diastolic
ASPIRE (6) 2011Post-MI with EF ≤45%8206036Aliskiren+ACEi vs. ACEi or ARB alone121.6/75.2121.7/75.4−2.1 mm Hg systolic
−2.4 mm Hg diastolic
ASTRONAUT (7) 2013Stable HHF pts1,6156549Aliskiren+ACEi or ARB vs. ACEi or ARB alone123.4123.1−1.2 mm Hg systolicLow
CALM II (8) 2005HTN and diabetes755552Candesartan+lisinopril vs. lisinopril139.1/83.8142.6/82.8−0.1 mm Hg systolic
+1 mm Hg diastolic
CHARM Added (9) 2003HF and EF ≤40%2,54864178Candesartan+any ACEi vs. ACEi alone124.7/75125.6/75.2−4.6 mm Hg systolic
−3.0 mm Hg diastolic
Cice et al. (10) 2010Hemodialysis pts with HF33263156Telmisartan+any ACEi vs. any ACEi124.5/82.6126.3/79.4Not reportedLow
Mehdi et al.(11) 2009Diabetes, HTN, albuminuria815048Losartan+lisinopril vs. lisinopril136/72132/74Not reportedHigh
ONTARGET (12) 2008High-risk CVD25,62067243Telmisartan+ramipril vs. ramipril and telmisartan141.9/82.1141.8/82.1−1.5 mm Hg systolic
−0.8 mm Hg diastolic
VALIANT (13) 2003AMI complicated by HF14,70365107Valsartan+captopril vs. Valsartan and captopril122.5/72.3122.8/72.4−2.2 mm Hg systolic
−1.0 mm Hg diastolic

ACEi = angiotensin-converting enzyme inhibitor; ALTITUDE = the Aliskiren Trial in Type 2 Diabetes Using Cardiovascular and Renal Disease Endpoints; AMI = acute myocardial infarction; ARB = angiotensin receptor blocker; ASPIRE = Aliskiren Study in Post-MI Patients to Reduce Remodeling; ASTRONAUT = the Aliskiren Trial on Acute Heart Failure Outcomes; BP = blood pressure; CALM = Candesartan and Lisinopril Microalbuminuria; CHARM = Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity; CVD = cardiovascular disease; DBP = diastolic blood pressure; DRI = direct renin inhibitor; EF = ejection fraction; HF = heart failure; HHF = hospitalizations for heart failure; HTN = hypertension; ONTARGET = the Ongoing Telmisartan alone and in combination with Ramipril Global endpoint trial; pts = patients; RAS = renin-angiotensin system; SBP = systolic blood pressure; VALIANT = Valsartan in Acute Myocardial Infarction Trial Investigators.

  • Diastolic blood pressure data not reported.