Renin-angiotensin-aldosterone system blockade effects on the kidney in the elderly: benefits and limitations

Area of Science:

• Gerontology
• Pharmacology
• Nephrology

Background:

• Global populations are aging, leading to more elderly patients with multiple chronic diseases like hypertension, diabetes, and chronic kidney disease (CKD).
• Overactive renin-angiotensin-aldosterone system (RAAS) contributes to hypertension, cardiovascular events, and CKD, making RAAS targeting a key therapeutic strategy.
• Elderly individuals present unique challenges for RAAS blocker therapy due to age-related physiological changes and polypharmacy.

Purpose of the Study:

• To review the benefits and limitations of RAAS blockade in elderly patients.
• To analyze the impact of RAAS blockers across different sites of the RAAS pathway in older adults.
• To evaluate combination RAAS blockade therapy and higher monotherapy dosing for hypertension in the elderly.

Main Methods:

• In-depth literature review focusing on RAAS blockers in the elderly population.
• Analysis of age-related changes affecting RAAS activity and drug response.
• Examination of data on combination therapy and higher monotherapy doses for hypertension management.

Main Results:

• Age-related declines in plasma renin activity and aldosterone increase risks like hyperkalemia in the elderly.
• Concurrent conditions and polypharmacy in older adults heighten the risk of adverse effects from RAAS blockers.
• Limited specific research exists on RAAS blocker use in elderly populations.

Conclusions:

• RAAS blockade is a logical approach for elderly patients with hypertension, cardiovascular disease, and CKD, but requires careful risk-benefit assessment.
• Understanding age-specific physiological changes and drug interactions is crucial for optimizing RAAS blocker therapy in older adults.
• Further research is needed to specifically address the efficacy and safety of RAAS blockers, including combination therapies and dosing strategies, in the elderly population.