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Editor's Correspondence
November 9, 2009

The Case for Dual Renin-Angiotensin System Inhibition

Arch Intern Med. 2009;169(20):1931. doi:10.1001/archinternmed.2009.406

Ku et al1 cite the findings of the Renal Outcomes With Telmisartan, Ramipril, or Both, in People at High Vascular Risk (ONTARGET) trial2 in arguing against dual renin-angiotensin system (RAS) inhibition in chronic kidney disease. However, the ONTARGET trial evaluated patients with less than 1 g of proteinuria, many of whom were normotensive. This was not a study of patients for whom nephrologists typically consider dual RAS inhibition; ONTARGET does not address, much less rebut, the efficacy of dual RAS inhibition that has been demonstrated in the hypertensive, proteinuric cohort.3

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