title: Dual renin-angiotensin-aldosterone blockade: promises and pitfalls.
abstract: Single renin-angiotensin-aldosterone system (RAAS) blockade has been shown to be effective and safe for the treatment of hypertension, coronary heart disease (CHD), heart failure (HF), diabetes, and chronic kidney disease (CKD) with proteinuria. Due to the action of RAAS blockers at various levels of the RAAS cascade, it was hypothesized that dual RAAS blockade would result in more complete inhibition of angiotensin II (Ang II) production and be more effective in blocking its detrimental cardiovascular remodeling effects. Unfortunately, several clinical trials in patients with hypertension, CHD, HF, and CKD with proteinuria have demonstrated no superiority of dual versus single RAAS blockade, but a higher incidence of adverse events. Based on these findings, dual RAAS blockade is no longer recommended for the routine treatment of various cardiovascular diseases, except diabetic nephropathy with proteinuria and HF with reduced ejection fraction. All the new information gathered from studies within the last 3 years will be presented in this review.
authors.affiliation: College of Medicine, University of Oklahoma, 5700 Mistletoe Court, Oklahoma City, OK, 73142, USA, schrysant@yahoo.com.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Chrysant
authors.forename: George S
authors.initials: GS
authors.lastname: Chrysant
mesh_terms: D000450:Aldosterone / Q000097:blood*; D000809:Angiotensins / Q000037:antagonists & inhibitors* / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D000092502:Renin Inhibitors
chemical_list: D000450:Aldosterone; D000809:Angiotensins; D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists; D012083:Renin; D000092502:Renin Inhibitors