RAAS inhibition/blockade in patients with cardiovascular disease: implications of recent large-scale randomised trials for clinical practice

摘要

Activation of the renin-angiotensin-aldosterone system (RAAS) has been shown to play an important role in cardiac and vascular injury and, conversely, inhibition and/or blockade of this system reduces cardiovascular mortality and morbidity across a wide spectrum of cardiovascular diseases. There remains, however, controversy as to how best to negate the adverse effects of RAAS activation. The results of the ONTARGET and TRANSCEND studies in patients with high-risk vascular disease, as well as a number of recent meta-analyses of randomised trials comparing the efficacy and safety of angiotensin converting enzyme inhibitors (ACEIs) with angiotensin receptor blocking agents (ARBs) and their combination in patients with heart failure (HF), hypertension, and chronic kidney disease, have focused attention on the RAAS and have provided some further insight into the most effective strategy to prevent the adverse effects of RAAS activation.