Safety outcomes between different drug combinations for dual blockade of the renin-angiotensin system (RAS) compared with monotherapy
| RAS blocker combination v. monotherapy | Relative risk (95% CI), P value | Interaction P value | |
|---|---|---|---|
| ACE inhibitors+angiotensin receptor blockers: | ACE inhibitors | Angiotensin receptor blockers | |
| Hyperkalaemia | 1.83 (1.35 to 2.50), 0.0001 | 1.34 (0.86 to 2.09), 0.19 | 0.26 |
| Hypotension | 2.02 (1.46 to 2.80), <0.001 | 1.44 (1.04 to 2.01), 0.03 | 0.15 |
| Renal failure | 1.55 (1.23 to 1.96), 0.0002 | 1.15 (0.92 to 1.43), 0.22 | 0.07 |
| Withdrawal owing to drug related adverse events | 1.21 (1.16 to 1.26), <0.001 | 1.39 (1.14 to 1.70), 0.001 | 0.18 |
| ACE inhibitors+aliskiren: | ACE inhibitors | Aliskiren | |
| Hyperkalaemia | 1.70 (1.11 to 2.58), 0.01 | 2.55 (1.00 to 6.46), 0.05 | 0.44 |
| Hypotension | 1.97 (1.17 to 3.30), 0.02 | No studies available | NA |
| Renal failure | 1.75 (0.92 to 3.34), 0.09 | 0.34 (0.04 to 3.24), 0.35 | 0.16 |
| Withdrawal owing to drug related adverse events | 0.97 (0.34 to 2.74), 0.95 | 0.56 (0.21 to 1.48), 0.24 | 0.45 |
| Angiotensin receptor blockers+aliskiren: | Angiotensin receptor blockers | Aliskiren | |
| Hyperkalaemia | 1.40 (1.02 to 1.91), 0.04 | 1.49 (0.83 to 2.68), 0.18 | 0.86 |
| Hypotension | 1.62 (0.70 to 3.74), 0.26 | 1.02 (0.66 to 1.56), 0.94 | 0.34 |
| Renal failure | 1.13 (0.52 to 2.47), 0.76 | 1.02 (0.36 to 2.93), 0.97 | 0.88 |
| Withdrawal owing to drug related adverse events | 1.06 (0.79 to 1.43), 0.70 | 1.19 (0.54 to 2.66), 0.67 | 0.79 |
ACE=angiotensin converting enzyme; NA=not applicable.