2.4.2.4 Multiple-Drug Therapy.
Multiple-drug therapy is often required to achieve blood pressure targets (Fig. 10.1), particularly in the setting of diabetic kidney disease. However, the use of both ACE inhibitors and ARBs in combination, or the combination of an ACE inhibitor or ARB and a direct renin inhibitor, is not recommended given the lack of added ASCVD beneļ¬t and increased rate of adverse eventsdnamely, hyperkalemia, syncope, and acute kidney injury (AKI) (58-60). Titration of and/or addition of further blood pressure medications should be made in a timely fashion to overcome clinical inertia in achieving blood pressure targets.