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Inhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?

Item Type:Review
Title:Inhibition of the renin-angiotensin-aldosterone system: is there room for dual blockade in the cardiorenal continuum?
Creators Name:Volpe, M. and Danser, A.H. and Menard, J. and Waeber, B. and Mueller, D.N. and Maggioni, A.P. and Ruilope, L.M.
Abstract:Antagonism of renin-angiotensin-aldosterone system is exerted through angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, renin inhibitors and mineralocorticoid receptor antagonists. These drugs have been successfully tested in numerous trials and in different clinical settings. The original indications of renin-angiotensin-aldosterone system blockers have progressively expanded from the advanced stages to the earlier stages of cardiorenal continuum. To optimize the degree of blockade of renin-angiotensin-aldosterone system, dose uptitrations of angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists or the use of a dual blockade, initially identified with the combination of angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists, have been proposed. The data from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) study do not support this specific dual blockade approach. However, the dual blockade of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists with direct renin inhibitors is currently under investigation while that based on an aldosterone blocker with any of the previous three drugs requires more evidence beyond heart failure. In this review, we revisited potential advantages of dual blockade of renin-angiotensin-aldosterone system in arterial hypertension and diabetes.
Keywords:Aldosterone Antagonists, Angiotensin II, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Type 1 Receptor Antagonists, Cardiovascular Complications, Cardiovascular Risk, Diabetes, Hypertension, Renal Diseases, Renin Inhibitors
Source:Journal of Hypertension
ISSN:0263-6352
Publisher:Lippincott Williams & Wilkins (U.S.A.)
Volume:30
Number:4
Page Range:647-654
Date:April 2012
Official Publication:https://doi.org/10.1097/HJH.0b013e32834f6e00
PubMed:View item in PubMed

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