The renin-angiotensin-aldosterone system in heart failure for the non-specialist: the past, the present and the future.
Heart failure is one of the major public health challenges facing the Western world. Its prevalence is increasing as the population ages and modern techniques are implemented to manage cardiac disease. In response, there has been a sustained effort to develop novel strategies to address the high levels of associated morbidity and mortality. Indeed, agents that target the renin-angiotensin-aldosterone system (RAAS) have transformed the way in which we manage heart failure. Despite this, mortality in heart failure is poorer than in many malignancies and a large burden of morbidity and recurrent hospitalisation remains. Here, we review the role of RAAS modulation within the field of systolic heart failure. In particular, we provide practical guidance on using current RAAS blockade agents and focus on the recent emergence of new agents that promise additional substantial benefit to those living with left ventricular systolic dysfunction.
North West Heart Centre, University Hospital of South Manchester, Manchester, UK.
Christopher
C
Orsborne
North West Heart Centre, University Hospital of South Manchester, Manchester, UK.|The University of Manchester, Manchester, UK.
Parminder S
PS
Chaggar
North West Heart Centre, University Hospital of South Manchester, Manchester, UK.|The University of Manchester, Manchester, UK.
Steven M
SM
Shaw
North West Heart Centre, University Hospital of South Manchester, Manchester, UK.|The University of Manchester, Manchester, UK.
Simon G
SG
Williams
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000613:Aminobutyrates / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D004338:Drug Combinations; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D015260:Neprilysin / Q000037:antagonists & inhibitors*; D012084:Renin-Angiotensin System; D013777:Tetrazoles / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000378:metabolism
D000319:Adrenergic beta-Antagonists; D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001713:Biphenyl Compounds; D004338:Drug Combinations; D000451:Mineralocorticoid Receptor Antagonists; D013777:Tetrazoles; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination
Angiotensin converting enzyme inhibitors; Angiotensin receptor and neprilysin inhibitor; Beta-blockers; Mineralocorticoid receptor antagonists; Renin-angiotensin-aldosterone system