Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: current status
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AbstractActivation of the renin-angiotensin-aldosterone system (RAAS) results in vasoconstriction, muscular (vascular and cardiac) hypertrophy and fibrosis. Established arterial stiffness and cardiac dysfunction are key factors contributing to subsequent cardiovascular and renal complications. Blockade of RAAS has been shown to be beneficial in patients with hypertension, acute myocardial infarction, chronic systolic heart failure, stroke and diabetic renal disease. An aggressive approach for more extensive RAAS blockade with combination of two commonly used RAAS blockers [ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)] yielded conflicting results in different patient populations. Combination therapy is also associated with more side effects, in particular hypotension, hyperkalaemia and renal impairment. Recently published ONTARGET study showed ACEI/ARB combination therapy was associated with more adverse effects without any increase in benefit. The Canadian Hypertension Education Program responded with a new warning: 'Do not use ACEI and ARB in combination'. However, the European Society of Cardiology in their updated heart failure treatment guidelines still recommended ACEI/ARB combo as a viable option. This apparent inconsistency among guidelines generates debate as to which approach of RAAS inhibition is the best. The current paper reviews the latest evidence of isolated ACEI or ARB use and their combination in cardiovascular diseases, and makes recommendations for their prescriptions in specific patient populations.
All Author(s) ListMa TKW, Kam KKH, Yan BP, Lam YY
Journal nameBritish Journal of Pharmacology
Year2010
Month7
Day1
Volume Number160
Issue Number6
PublisherWiley: 12 months
Pages1273 - 1292
ISSN0007-1188
eISSN1476-5381
LanguagesEnglish-United Kingdom
Keywordsangiotensin converting enzyme inhibitors; angiotensin II type 1 receptor blockers; diabetic nephropathy; heart failure; hypertension; myocardial infarction; renin-angiotensin-aldosterone system; stroke
Web of Science Subject CategoriesPharmacology & Pharmacy; PHARMACOLOGY & PHARMACY

Last updated on 2020-24-09 at 00:15