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Combination ACE inhibitor and angiotensin receptor blocker therapy was better than monotherapy in non-diabetic renal disease

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 QUESTION: In patients with non-diabetic renal disease, what is the effectiveness of the angiotensin II receptor blocker (ARB) losartan, the angiotensin converting enzyme (ACE) inhibitor trandolapril, or the 2 drugs combined for delaying disease progression?


Randomised (unclear allocation concealment*), blinded (clinicians, patients, data collectors, and monitoring committee),* controlled trial with 3 years of follow up.


Hospital outpatient renal clinic serving 3 cities in Japan.


301 patients 18–70 years of age who had chronic non-diabetic renal insufficiency, persistent proteinuria, and no history of allergic reaction to drugs. Exclusion criteria included immediate need for renal replacement therapy; need for corticosteroids, non-steroidal anti-inflammatory drugs, or immunosuppressive drugs; proteinuria >10 g/day and hypoalbuminaemia <28 g/l; other serious disease; and pregnancy or breastfeeding. 263 patients …

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  • Source of funding: in part, Ministry of Health, Labour, and Welfare, Japan.

  • For correspondence: Dr N Nakao, Showa University, Yokohama, Japan. lancetjp{at}

  • Abstract and commentary also appear in ACP Journal Club.

  • * See glossary.