ABSTRACT
In summary, these two classes of drugs act via distinct mechanisms: ACE inhibitors reduce the levels of angiotensin II, by blocking its production, and increase the levels of bradykinin, by blocking its degradation; while ARBs exert complete blockade of the AT1 receptors and lead to increased stimulation of the AT2 receptors. Because of this, the combined use of ACE inhibitor and ARB therapy has been suggested to have a “synergistic” effect. The ACE inhibitor will increase the levels of kinins, while the ARB blocks the adverse effects of angiotensin II that is generated via the ACE escape mechanism. In
addition, combining both classes of drugs can effect a more complete inhibition of the RAAS in the face of the reactive increases in renin and consequently in angiotensin levels seen with either therapy alone (13).
