Renin-angiotensin-aldosterone system (RAAS) pharmacogenomics: implications in heart failure management.
Blockade of the renin-angiotensin-aldosterone system (RAAS) with ACE inhibitors has been a cornerstone of heart failure therapy for over 15 years. More recently, further blockade of RAAS with aldosterone antagonists and angiotensin receptor blockers (ARBs) has been studied. While these therapies have certainly improved outcomes in the treatment of heart failure, morbidity and mortality remain extremely high. Furthermore, polypharmacy and complex regimens of seven medications on average is the norm for management of heart failure. This results in increased costs, patient burden, and uncertainty as to the best course of therapy. The ability to personalize patients' therapeutic regimens using pharmacogenomics has the potential of providing more effective and efficient use of RAAS-modulating medications. This review highlights the implications of major RAAS pharmacogenetic studies, while outlining future directions for translation to practice.
Beitelshees
Amber L
AL
Department of Pharmacy Practice and Center for Pharmacogenomics, University of Florida College of Pharmacy, PO Box 100486, Gainesville, FL 32610, USA. beitel@cop.ufl.edu
Zineh
Issam
I
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000235:genetics; D006333:Heart Failure / Q000188:drug therapy / Q000235:genetics*; D006801:Humans; D006973:Hypertension / Q000235:genetics; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D007703:Peptidyl-Dipeptidase A / Q000235:genetics; D010597:Pharmacogenetics; D010641:Phenotype; D011945:Receptors, Angiotensin / Q000235:genetics; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000235:genetics
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D011945:Receptors, Angiotensin; D007703:Peptidyl-Dipeptidase A