[Inhibition of renin-angiotensin-aldosterone system: what evidence?]

The activation of various neuro-humoral systems is involved in the progression of chronic heart failure. The pharmacological blockade of the renin-angiotensin-aldosterone system is possible with agents such as angiotensin converting enzyme inhibitors (ACEI), the angiotensin II receptor antagonists (ARA) and the aldosterone antagonists. The actual scientific evidence supports the use of the ACEI in patient with ventricular dysfunction in all functional NYHA classes, of the ARA in heart failure patients with intolerance to ACEI and of low-dose spironolactone in patients with severe heart failure. Ongoing clinical trials will further clarify the role of these pharmacological agents in the management of chronic heart failure patients.