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RAS inhibition in hypertension.
11Cardiology Department, Faculty of Medicine, Cairo University, Abdeen, Cairo, Egypt. ehs@link.net
Journal of Human Hypertension
|January 7, 2006
Summary
Renin-angiotensin system (RAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor antagonists (ARA), offer benefits beyond blood pressure reduction. They are crucial for managing hypertension, particularly in patients with diabetes or kidney issues.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Renin-angiotensin system (RAS) inhibitors, such as ACE-I and ARA, are increasingly used for hypertension.
- ACE-I were the most prescribed hypertension drugs in the USA in 2002.
- These drugs offer good tolerability and a favorable metabolic profile compared to other antihypertensives.
Purpose of the Study:
- To evaluate the efficacy and benefits of RAS inhibitors in hypertension management.
- To compare RAS inhibitors with other antihypertensive agents regarding mortality and cardiovascular events.
- To explore benefits beyond blood pressure lowering, such as organ protection and diabetes prevention.
Main Methods:
- Review of large clinical trials comparing ACE-I and ARA with other antihypertensive agents (diuretics, beta-blockers, calcium antagonists).
- Analysis of cardiovascular and total mortality data.
- Assessment of prevention of cardiovascular morbid events, including stroke, heart failure, and coronary heart disease.
- Evaluation of effects on diabetes mellitus development and end-organ protection (kidneys, blood vessels, heart).
Main Results:
- ACE-I and ARA showed similar antihypertensive efficacy as monotherapy compared to other agents.
- No additional advantages in cardiovascular or total mortality were observed compared to other agents.
- ARA demonstrated superiority in stroke prevention; ACE-I showed superiority over calcium antagonists in preventing heart failure.
- RAS inhibitors demonstrated benefits in preventing or delaying diabetes and provided superior end-organ protection at equivalent blood pressure reduction.
Conclusions:
- RAS inhibitors are valuable for hypertension, especially in patients with specific conditions like diabetes, kidney disease, or heart failure.
- Combined ACE-I and ARA therapy is particularly beneficial for organ protection.
- While not superior in all mortality outcomes, RAS inhibitors offer distinct advantages in preventing diabetes and protecting organs.