Role of RAAS Inhibition in the Prevention of Cardiovascular Disease
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The pathogenesis of cardiovascular disease is a complex and dynamic process. The renin-angiotensin-aldosterone system (RAAS) is a potent and powerful mediator in the homeostasis of the cardiovascular and renal systems. RAAS blockade via angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has been consistently proven to be an effective and safe strategy for the primary and secondary prevention of cardiovascular disease in patients across a wide spectrum of risk. Although the beneficial effects of RAAS blockade may be due to its effects on central and peripheral blood pressure, there are many additional mechanisms to consider that may contribute additional protection. While a combination of ACE inhibitors and ARBs has not yielded significantly positive results, the newer class of direct renin inhibitors (DRIs) may offer a novel and effective strategy for monotherapy as well as in combination.
- Duprez DA. Role of the renin-angiotensin0aldosteorne system in vascular remodeling and inflammation: a clinica review. J Hypertens. 2006;24:983–1. CrossRef
- Atlas S: The renin-angiotensin-aldosterone system: pathophysiological role and pharmacologic inhibition. J Manag care Pharm 2007; 131(Suppl B).
- Kumar R, Singh V, Baker K. The intracellular renin-angiotensin system: implications in cardiavascular remodeling. Curr Opin Nephrol Hypertens 2008; 168.
- Rutherford JD, Pfeffer MA, Moye LA, et al. Effects of captopril on ischaemic events after myocardial infarction: results of the survival and ventricular enlargement trial. Circulation. 1994;90:1731–8.
- The Heart Outcomes Prevention Evaluation Study Investigators. Effects on an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. NEJM. 2000;342:145–53. CrossRef
- Fox KM, for the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782–8. CrossRef
- Rouleau JL, Warnica WJ, Baillot R, Block PJ, Chocron S, Johnstone D, et al. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery. Circulation. 2008;117:24–31. CrossRef
- Svensson P, de Faire U, Sleight Peter, Yusuf S, Ostergren J. Comparative effects of ramipril on ambulatory and office blood pressures. Hypertension. 2001;38:e28. CrossRef
- Snow V, Barry P, Fihn SD, et al. Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2004;141:562–7.
- Dagenais GR, Pogue J, Simoons ML, Yusef S. Angiotensin-coverting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet. 2006;368:581–88. CrossRef
- Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52. CrossRef
- Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regiment of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet. 2005;366:895–906. CrossRef
- Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417–8. CrossRef
- Bakris GL, Sarafidis PA, Weir MR. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet. 2010;375:1173–81. CrossRef
- Dahlof B, Devereuz RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the losartan intervention for endpoint reduction in hypertension (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003. CrossRef
- Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113(9):1213–25. CrossRef
- Julius S, Kjeldsen SE, Weber M, Brunner HR, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet. 2004;363:2022–31. CrossRef
- Granger CB, McMurray JJV, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left ventricular systolic function intolerant to angiotensin-converting enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003;362:772–6. CrossRef
- Verma S, Stauss M. Angiotensin Receports blockers and myocardial infarction. BMJ. 2004;329:1248–9. CrossRef
- Sipahi I, Debanne SM, Rowland DY, et al. Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials. Lancet Oncol. 2010;11(7):627–3. CrossRef
- European Medicines Agency. Monthly report: Committee for Medicinal Products for Human Use (CHMP). June 21–24, 2010.
- Bangalore S, Kumar S, Kjeldsen SE, et al. Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324 168 participants from randomised trials. Lancet Oncol. 2010;12:65–82. CrossRef
- Muhlestein JB, May HT, Bair TL, et al. Relation of elevated plasma renin activity at baseline to cardiac events in patients with angiographically proven coronary artery disease. Am J Cardiol. 2010;106:764–9. CrossRef
- Alderman MH, Madhavan S, Ooi WL, et al. Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med. 1991;324:1098–4. CrossRef
- Masson S, Solomon S, Angelici L, et al. Plasma renin activity retains a strong prognostic value in patients with chronic HF, independent of ACE inhibitor or beta-blocker therapy. Data from the Valsartan Heart Failure (Val-HeFT) trial. Eur Heart J 2009; 30(suppl):163 (1099).
- Solomon SD, Appelbaum E, Manning WJ, et al. Effect of the direct renin inhibitor aliskiren, the angiotensin receptor blocker losartan, or both on left ventricular mass in patients with hypertension and left ventricular hypertrophy. Circulation. 2009;119:530–7. CrossRef
- Parving H-H, Persson F, Lewis JB, et al. Aliskiren combined with losartan in type 2 diabetes and nephropathy. New Engl J Med. 2008;358:2433–46. CrossRef
- McMurray JV, Pitt B, Latini R. Effects of the oral direct renin inhibitor aliskiren in patients with symptomatic heart failure. Circ Heart Fail. 2008;1:17–24. CrossRef
- Parving HH, Brenner BM, McMurray JJ, et al. Aliskiren trial in type 2 diabetes using cardio-renal endpoints (ALTITUDE): rationale and study design. Nephrol Dial Transplant. 2009;24(5):1663–71. CrossRef
- Manisty CH, Zambanini A, Parker KH, et al. Differences in the magnitude of wave reflection account for differential effects of amlodipine-based versus atenolol-based regimens on central blood pressure: an anglo-scandinavian cardiac outcome trial substudy. Hypertension. 2009;54:724–30. CrossRef
- Role of RAAS Inhibition in the Prevention of Cardiovascular Disease
Current Treatment Options in Cardiovascular Medicine
Volume 13, Issue 4 , pp 279-288
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links