Related Experiment Videos
Angiotensin II blockade: a therapeutic strategy with wide applications
Juan M Aranda1, C Richard Conti
1Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida 32610, USA. Arandjm@mail-cs.med.ufl.edu
Abstract:
Evidence now exists suggesting a pathologic role for angiotensin II in patients with cardiovascular disease and those with risk factors. Clinical trials such as the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE), the Heart Outcomes Prevention Evaluation Study (HOPE), the African American Study of Kidney Disease and Hypertension (AASK), and the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study have clearly demonstrated that blood pressure reduction is important in hypertension and diabetes. If this can be accomplished with agents that block the renin-angiotensin system, then additional clinical benefit will be achieved. Clinical data on angiotensin-converting enzyme inhibitors (ACEIs) are well established, while emerging data on the use of angiotensin II receptor blockers (ARBs) continue to grow. There is evidence supporting the concept of angiotensin II escape in the presence of ACEIs. The question that remains to be answered is whether a combination of both agents (ACEIs and ARBs) can improve clinical outcomes. Ongoing clinical trials will answer this question.
Insights
Blocking the renin-angiotensin system is key for managing hypertension and diabetes. Combining angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) may offer further clinical benefits in cardiovascular disease.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Angiotensin II plays a pathologic role in cardiovascular disease and associated risk factors.
- Clinical trials demonstrate the importance of blood pressure reduction in hypertension and diabetes.
Purpose of the Study:
- To evaluate the clinical benefits of blocking the renin-angiotensin system.
- To explore the potential advantages of combining angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).
Main Methods:
- Review of clinical trial data, including LIFE, HOPE, AASK, and RENAAL studies.
- Analysis of established data on ACEIs and emerging data on ARBs.
Main Results:
- Blood pressure reduction is crucial for managing hypertension and diabetes.
- ACEIs have well-established clinical data; ARB data are growing.
- Evidence suggests "angiotensin II escape" can occur with ACEIs.
Conclusions:
- Agents blocking the renin-angiotensin system offer additional clinical benefits.
- The combination of ACEIs and ARBs requires further investigation to determine its impact on clinical outcomes.
- Ongoing clinical trials are designed to answer the question of combined ACEI and ARB efficacy.