Renal protective effect of RAAS blockade across the renal continuum, with a review of the efficacy and safety of valsartan.
Abstract Objective: The purpose of this report is to review key data on the angiotensin receptor blocker (ARB) valsartan, along with data from several pivotal studies with other ARBs and angiotensin-converting enzyme (ACE) inhibitors, to highlight the beneficial class effects of renin-angiotensin-aldosterone system (RAAS) blockade throughout the renal continuum.


METHODS
The selection of articles was based on a search of PubMed for clinical trials published between 1997 (the year in which valsartan was approved for sale in the US) and 2009 that involved valsartan and reported effects on renal function, plus a select range of articles on other agents acting on the RAAS, including key guidance documents issued during this time.


CONCLUSIONS
Valsartan has been studied extensively and is widely used for the management of hypertension. Data from clinical studies involving valsartan and other ARBs and ACE inhibitors provide evidence of an additional renal protective effect. This renal protection apparently arises from hemodynamic, endothelial, and anti-inflammatory actions.


CONCLUSIONS
Given the extent of the available literature on this topic, this review included only a subset of available publications. This report may reflect inherent heterogeneity between patient populations from these studies and also incorporate the limitations of these individual publications. The inclusion of guidance documents from several organizations may have resulted in apparent minor conflicts in the approaches of the different groups.
Locatelli
Francesco
F
A Manzoni Hospital, Lecco, Italy.
Palmer
Biff F
BF
Kashihara
Naoki
N
Ecder
Tevfik
T
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D019610:Cytoprotection / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D006977:Hypertension, Renal / Q000517:prevention & control*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008954:Models, Biological; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013777:Tetrazoles / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000068756:Valsartan
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine