Renin Angiotensin Aldosterone System Inhibitors in Hypertension: Is There Evidence for Benefit Independent of Blood Pressure Reduction?

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• 作者：Chirag Bavishi^a ; Sripal Bangalore^b ; Franz H. Messerli^c ; ^{messerli.f@gmail.com}
• 关键词：ACEI ; Angiotensin converting enzyme inhibitors ; ARB ; Angiotensin receptor blocker ; BP ; Blood pressure ; CCB ; Calcium channel blocker ; CHD ; Coronary heart disease ; CKD ; Chronic kidney disease ; CV ; Cardiovascular ; DRI ; Direct renin inhibitor ; HF ; Heart failure ; HTN ; Hypertension or hypertensive ; ISH ; Isolated systolic hypertension ; MI ; Myocardial infarction ; RAAS ; Renin-angiotensin-aldosterone system
• 刊名：Progress in Cardiovascular Diseases
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：59
• 期：3
• 页码：253-261
• 全文大小：542 K
• 卷排序：59

文摘

The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in the pathogenesis of hypertension (HTN). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are first line anti-HTN drug classes that are potent, effective and largely safe. Direct renin inhibitors (DRIs) have shown similar blood pressure (BP) reduction but more side effects. The efficacy of ACEIs and ARBs (for cardiovascular, cerebrovascular and renal protection) has been promoted to extend beyond what could be explained by BP reduction alone. In the current review, we will briefly discuss the (1) pathophysiology of renin-angiotensin-aldosterone system (RAAS) system, (2) clinical evidence for ACEIs, ARBs and DRIs in HTN, (3) comparison of ACEIs vs. ARBs and combination therapy, (4) role of RAAS inhibitors in specific patient populations, (5) safety profile of RAAS inhibitors, and (6) guideline recommendations and future perspectives. Closer scrutiny of outcome data shows little, if any, evidence that the efficacy of RAAS blockers in HTN extends beyond BP reduction.