[Renin-angiotensin system modulation: instructions for use].
Angiotensin-converting enzyme (ACE) inhibitors and AT1 receptor blockers have long been considered as two classes of drugs with strictly comparable effect in cardiovascular diseases, on the assumption that both classes act on the renin-angiotensin-aldosterone system. The results of large clinical intervention trials, which failed to demonstrate any significant difference between the effects of these two pharmacological classes in patients with essential hypertension, acute myocardial infarction and heart failure, supported this concept. The recent observation that a combination of ACE-inhibitors and AT1 receptor blockers improves the prognosis of these pathological conditions better than monotherapy at higher doses focused on the difference between their mechanisms of action. The results of pathophysiological studies have suggested that in the heart, as well as in the kidney, AT1 receptor blockers act in the early stages of the disease, improving left ventricular dysfunction in hypertensive patients and preventing microalbuminuria in diabetic animals. It seems reliable to suggest that AT1 receptor blockers are to be preferred to ACE-inhibitors for an early prevention of cardiovascular and renal disease. The new inhibitors of renin activity may further amplify our chances, also blocking the negative effects mediated by angiotensin II escape and by stimulation of the prorenin/renin receptors.
Bellis
Alessandro
A
Dipartimento di Medicina Clinica, Scienze Cardiovascolari e Immunologiche, Università degli Studi Federico II, Napoli.
Rozza
Francesco
F
Crispo
Salvatore
S
Trimarco
Bruno
B
D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects*; D000092502:Renin Inhibitors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000092502:Renin Inhibitors