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Progression of cardiovascular damage: the role of renin-angiotensin system blockade

Jeffrey L Probstfield1, Kevin D O'Brien

  • 1Clinical Trials Service Unit, Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA. jeffprob@u.washington.edu

The American Journal of Cardiology
|January 28, 2010
PubMed

Insights

Blockading the renin-angiotensin system (RAS) with ACE inhibitors or ARBs is crucial for managing cardiovascular disease (CVD). These therapies offer cardiovascular protection through various mechanisms, including antiatherogenic actions.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Endocrinology

Background:

  • The renin-angiotensin system (RAS) is integral to cardiovascular health.
  • Blockade of the RAS via ACE inhibition or AT(1) receptor antagonism is a cornerstone in managing cardiovascular disease (CVD).
  • Recent discoveries reveal new RAS pathways and peptides, offering novel therapeutic targets.

Purpose of the Study:

  • To review the established and emerging roles of the renin-angiotensin system (RAS) in cardiovascular disease (CVD).
  • To elucidate the mechanisms by which ACE inhibitors and ARBs provide cardiovascular benefits.
  • To discuss the therapeutic implications of targeting the RAS for CVD prevention and treatment.

Main Methods:

  • Review of current literature on the renin-angiotensin system (RAS) and its modulation in cardiovascular disease (CVD).
  • Analysis of the pharmacological actions and clinical benefits of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 (AT(1)) receptor blockers (ARBs).
  • Synthesis of evidence regarding the antiatherogenic and cardioprotective effects of RAS-blocking agents.

Main Results:

  • ACE inhibitors confer benefits through reduced angiotensin II and increased bradykinin, impacting vasodilation, endothelial function, and cell proliferation.
  • ARBs selectively block AT(1) receptors, allowing unopposed AT(2) receptor stimulation with potential vasodilatory, anti-inflammatory, and antiproliferative effects.
  • Both ACE inhibitors and ARBs demonstrate significant antiatherogenic actions and reduce clinical events in high-risk individuals.

Conclusions:

  • ACE inhibitors and ARBs are vital therapeutic strategies for cardiovascular disease (CVD) management and secondary prevention.
  • Understanding novel RAS pathways and peptides like angiotensin-(1-7) may lead to new therapeutic interventions.
  • Current guidelines recommend ACE inhibitors and ARBs for secondary CVD prevention due to their proven clinical benefits.

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