The evolving landscape of RAAS inhibition: from ACE inhibitors to ARBs, to DRIs and beyond

• Published in: Expert review of cardiovascular therapy Vol. 10; no. 6; pp. 713 - 725
• Main Authors: Epstein, Benjamin J, Leonard, Paul T, Shah, Niren K
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01.06.2012; Taylor & Francis; Expert Reviews Ltd
• Subjects: (pro)renin receptor; ACE inhibitor; ACE inhibitors; Angiotensin Receptor Antagonists - pharmacology; Angiotensin Receptor Antagonists - therapeutic use; angiotensin receptor blocker; Angiotensin-Converting Enzyme Inhibitors - pharmacology; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Animals; Cardiovascular diseases; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - physiopathology; direct renin inhibitor; Health aspects; Hemodynamics; Humans; Kidney Diseases - drug therapy; Kidney Diseases - physiopathology; Physiological aspects; plasma renin activity; Renin - antagonists & inhibitors; Renin-angiotensin system; Renin-Angiotensin System - drug effects; Risk Factors
• ISSN: 1477-9072; 1744-8344
• DOI: 10.1586/erc.12.63

Chronic renin-angiotensin-aldosterone system (RAAS) activation has far-reaching effects on cardiometabolic risk and is a substantial contributor to cardiovascular (CV) disease and renal dysfunction. The vascular effects of sustained RAAS activation are associated with hemodynamic imbalances, as well as inflammatory stimulation and prothrombotic processes that lead to fibrosis, endothelial dysfunction and cellular remodeling. RAAS inhibition therapies, which include the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and more recently, direct renin inhibitors, have been used in clinical practice for more than 30 years. Our understanding of how these drugs work, alone and in combination, has contributed to an expanding landscape of treatment options and established RAAS inhibition as essential for reducing the risk of CV and renal disease. This perspective provides a historical overview of how RAAS inhibitors have evolved to their present-day status and will discuss recently discovered functions for components of this complicated and powerful regulatory system.