Combined Blockade of the Renin Angiotensin System with ACE Inhibitors and AT1 Receptor Antagonists
| Autor: | J. Ménard, M. Azizi |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Angiotensin receptor Angiotensin II receptor type 1 biology business.industry Angiotensin-converting enzyme Pharmacology medicine.disease Blockade Endocrinology Internal medicine Heart failure ACE inhibitor Renin–angiotensin system medicine biology.protein business Ventricular remodeling medicine.drug |
| Zdroj: | Angiotensin Vol. II ISBN: 9783540406419 |
| Popis: | The results from experimental models and randomized controlled clinical trials have shown that the more intense the blockade of the renin-angiotensin system (RAS) is during angiotensin I-converting enzyme (ACE) inhibition or AT1 receptor blockade, the more effective the prevention of target organ damage is. Combined inhibition of the RAS is aimed at more complete blockade of the system through action at two different sites: ACE and AT1 receptors. This is achieved either by neutralizing the rise in renin and angiotensin (Ang) I, which follows the interruption of the Ang II-renin negative feedback loop, or by directly antagonizing Ang II, whose synthesis is in part independent of the RAS, as nonrenin-dependent pathways have been identified in cardiac and vascular tissues. By comparison with higher doses of single-site blockers , a combination of an ACE inhibitor and an AT1 receptor antagonist blocks the RAS more effectively. After demonstrating the synergistic or additive blood pressure effects of the combined RAS blockade in sodium-depleted normotensive subjects and animal models, the combined blockade of the RAS was shown to be more efficient than single-site blockade (a) in lowering BP in Caucasian hypertensive patients with predominantly low renin concentrations, with type II diabetes or with renal failure, (b) in lowering proteinuria and possibly retarding progression of renal failure in patients with diabetic and nondiabetic nephropathy, and (c) in finally improving left ventricular remodeling, cardiac function status and cardiovascular morbidity and mortality in patients with congestive heart failure. The advantage offered by combining two RAS blockers is to increase the beneficial effect of cardioprotection and nephroprotection, which are currently achieved with the highest doses of an ACE inhibitor or an AT1 receptor antagonist |
| Databáze: | OpenAIRE |
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