Role of the Renin-Angiotensin-Aldosterone System and Its Pharmacological Inhibitors in Cardiovascular Diseases: Complex
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POSITION PAPER
Role of the Renin-Angiotensin-Aldosterone System and Its Pharmacological Inhibitors in Cardiovascular Diseases: Complex and Critical Issues Claudio Borghi1 • SIIA Task Force • Francesco Rossi2 • SIF Task Force
Received: 8 September 2015 / Accepted: 9 September 2015 Ó Springer International Publishing Switzerland 2015
Abstract Hypertension is one of the major risk factor able to promote development and progression of several cardiovascular diseases, including left ventricular hypertrophy and dysfunction, myocardial infarction, stroke, and congestive heart failure. Also, it is one of the major driven of high cardiovascular risk profile in patients with metabolic complications, including obesity, metabolic syndrome and diabetes, as well as in those with renal disease. Thus, effective control of hypertension is a key factor for any preventing strategy aimed at reducing the burden of hypertension-related cardiovascular diseases in the clinical practice. Among various regulatory and contra-regulatory systems involved in the pathogenesis of cardiovascular and renal diseases, reninangiotensin system (RAS) plays a major role. However, despite the identification of renin and the availability of various assays for measuring its plasma activity, the specific pathophysiological role of RAS has not yet fully characterized. In the last years, however, several notions on the RAS have been improved by the results of large, randomized clinical trials, performed in different clinical settings C. Borghi: On behalf of the SIIA Task Force. F. Rossi: On behalf of the SIF Task Force. The list of the members of the SIIA and SIF Task Force are given in ‘‘Appendix’’. & Claudio Borghi [email protected] 1
Chair of Internal Medicine, Department of Medical and Surgical Sciences, Division of Internal Medicine, Ospedale Policlinico Sant’Orsola-Malpighi, University of Bologna, Via Albertoni, 15, 40138 Bologna, Italy
2
Department of Medical Pathophysiology, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
and in different populations treated with RAS inhibiting drugs, including angiotensin converting enzyme (ACE) inhibitors and antagonists of the AT1 receptor for angiotensin II (ARBs). These findings suggest that the RAS should be considered to have a central role in the pathogenesis of different cardiovascular diseases, for both therapeutic and preventive purposes, without having to measure its level of activation in each patient. The present document will discuss the most critical issues of the pathogenesis of different cardiovascular diseases with a specific focus on RAS blocking agents, including ACE inhibitors and ARBs, in the light of the most recent evidence supporting the use of these drugs in the clinical management of hypertension and hypertension-related cardiovascular diseases. Keywords Renin-angiotensin system Angiotensin converting enzyme inhibitors Angiotensin receptor blockers Hypertension Myocardial infarction Stroke Heart failure Renal disease Cardiovascular diseases
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