Inhibition of RAAS--when is it too much?
Deactivation of the renin-angiotensin-aldosterone system (RAAS) is clearly beneficial in patients with recent myocardial infarction and chronic heart failure. Most of the experience with deactivation of the RAAS has been collected in placebo-controlled randomized trials of angiotensin- converting enzyme inhibition (ACEI). The hypothesis that angiotensin receptor blockade may be a better approach to deactivate the RAAS has not survived the test of time. Despite the extensive experience with ACEI and aldosterone receptor blockade in patients with recent myocardial infarction and chronic heart failure, several issues remain unanswered. These are addressed in this review.
Navarro
Pablo
P
Room G-46 Forchheimer Building, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
Moskowitz
Robert
R
Le Jemtel
Thierry H
TH
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D044383:Black People; D001920:Bradykinin / Q000378:metabolism; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D001920:Bradykinin