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This editorial refers to ‘Clinical impacts of additive use of olmesartan in hypertensive patients with chronic heart failure: the supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan (SUPPORT) trial’[†][1], by Y. Sakata et al. , on page 915. The Supplemental Benefit of an Angiotensin Receptor Blocker in Hypertensive Patients with Stable Heart Failure Using Olmesartan (SUPPORT, NCT00417222) trial, a prospective, randomized, open-label blinded endpoint study reported by Sakata et al . in this issue of the journal, demonstrated that additive use of angiotensin receptor blockers (ARBs) did not improve clinical outcomes but worsened renal function in hypertensive patients with symptoms of heart failure (HF) treated with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers.1 In particular, the triple combination therapy with olmesartan, ACE inhibitors, and beta-blockers was associated with increased incidence of all-cause death and renal dysfunction, whereas the dual combination of olmesartan and ACE inhibitors or beta-blockers was not associated with any increase in primary [composite of all-cause death, non-fatal acute myocardial infarction, non-fatal stroke, and worsening chronic HF (CHF) requiring hospitalization] or secondary (the modes of death, hospitalization for cardiovascular reasons, surrogate markers for CHF, and development of cardiovascular disease, atrial fibrillation, diabetes, and renal failure) endpoint. Furthermore, combination of olmesartan and beta-blockers was associated with decreased mortality without development of renal dysfunction.Neurohormonal dysregulation plays a crucial role in the pathophysiology of HF with reduced ejection fraction (HFrEF). The strategy of inhibiting the renin–angiotensin–aldosterone system (RAAS) has led to remarkable advances … [1]: #fn-2

Too much is too much: evidence against dual RAAS inhibition in hypertensives with heart failure symptoms