Manipulation of the renin angiotensin system in peripheral arterial disease.
The Heart Outcomes Prevention Evaluation (HOPE) study has provided evidence for the use of ramipril for secondary cardiac prevention for patients with peripheral arterial disease. Despite this many vascular surgeons and general practitioners are reluctant to prescribe ACE inhibitors in a group of patients perceived to have a high incidence of renal artery stenosis. This review aims to review the pathophysiology of the renin-angiotensin system and make evidence based recommendations for commencing ACE inhibitors as part of a comprehensive delivery of best medical therapy to patients with peripheral arterial disease.
Hobbs
S D
SD
University Department of Vascular Surgery, Birmingham Heartlands and Solihull NHS Trust (Teaching), Birmingham, UK. simon@hobbsy.fsworld.co.uk
Thomas
M E
ME
Bradbury
A W
AW
D000465:Algorithms; D000804:Angiotensin II / Q000502:physiology; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D015897:Comorbidity; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D017257:Ramipril / Q000627:therapeutic use; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000804:Angiotensin II; D017257:Ramipril