Inhibition of the renin-angiotensin-aldosterone system to prevent ischemic and atherothrombotic events.
Blood pressure (BP) is a continuous risk factor for ischemic and atherosclerotic events such as stroke and ischemic heart disease, and controlling BP is a well-established component of any cardiovascular or cerebrovascular risk reduction regimen. In most patients, > or =2 medications with different mechanisms of action will be necessary to reach recommended BP goals. The neuroendocrine effects of the renin-angiotensin-aldosterone-system (RAAS) have proven to be excellent therapeutic targets for BP lowering. A number of antiatherosclerotic effects have been attributed to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in addition to their antihypertensive effects. Because they have complementary actions on the RAAS, combination therapy with these agents has become the focus of recent clinical trials. This review describes the clinical data assessing the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually and in combination in reducing the risk of stroke and ischemic heart disease.
Papademetriou
Vasilios
V
Department of Veterans Affairs and Georgetown University Medical Centers, Washington, DC 20422, USA. papavip@aol.com
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011945:Receptors, Angiotensin / Q000627:therapeutic use; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin