Hemodynamic effects of inhibitors of the renin-angiotensin system

To review the hemodynamic effects of the various classes of inhibitors of the renin-angiotensin system. DATA PRESENTATION: First, hemodynamic alterations related to inhibition of the renin-angiotensin system were defined. Second, some comparative studies on the various types of inhibitors were examined.

Angiotensin converting enzyme (ACE) inhibitors have been well studied in both hypertension and heart failure and have been shown to produce both arteriolar and venous dilation. Renin inhibitors have been shown to achieve equipotent blood pressure reductions to those induced by ACE inhibitors in experimental studies; the mechanism of blood pressure reduction was related to a decrease in systemic resistance, without altering the heart rate or cardiac output. Angiotensin II antagonists are still being studied.

It may be still too early to predict how useful the renin inhibitors and the angiotensin II antagonists will be for the therapy of cardiovascular diseases, compared with ACE inhibitors.