The evolution of renin-angiotensin blockade: angiotensin-converting enzyme inhibitors as the starting point.
The renin-angiotensin system has been a target in the treatment of hypertension for close to three decades. Several medication classes that block specific aspects of this system have emerged as useful therapies, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and, most recently, direct renin inhibitors. There has been a natural history to the development of each of these three drug classes, starting with their use as antihypertensive agents; thereafter, in each case they have been employed as end-organ protective agents. To date, there has been scant evidence to favor angiotensin receptor blockers or direct renin inhibitors over angiotensin-converting enzyme inhibitors in treating hypertension or in affording end-organ protection; thus, angiotensin-converting enzyme inhibitors remain the standard of care when renin-angiotensin system blockade is warranted.
Sica
Domenic A
DA
Clinical Pharmacology and Hypertension, Virginia Commonwealth University Health System, Sanger Hall, Room 8-062, Richmond, VA 23298-0160, USA. dsica@mcvh-vcu.edu
D047228:Angiotensin II Type 1 Receptor Blockers / Q000266:history / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000266:history / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000266:history / Q000494:pharmacology / Q000627:therapeutic use*; D004232:Diuretics / Q000266:history / Q000627:therapeutic use; D049673:History, 20th Century; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000266:history / Q000473:pathology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D000092502:Renin Inhibitors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D000092502:Renin Inhibitors