Reviews for Primary Care - Fall 2007 - (Page 30) TREATMENT UPDATE Inhibiting the Renin-Angiotensin System to Prevent Cardiovascular Diseases: Do We Need a More Comprehensive Strategy? Michael A. Weber, MD,* Thomas D. Giles, MD† *State University of New York Downstate Medical Center, Brooklyn, NY; †Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA The renin-angiotensin system (RAS) plays a pivotal role in the progression of some forms of hypertension and cardiovascular disease. The development of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has provided physicians with effective and well-tolerated inhibitors of the RAS. However, it remains open to question whether ACE inhibitors and ARBs have fully delivered the reductions in cardiovascular risk that we might have expected. There is little doubt that in conditions such as chronic and acute heart failure or diabetic nephropathy these drugs have provided significant protection. But, in patients with high-risk hypertension, for instance, the anticipated benefits of RAS blockade have been less obvious. This article provides a critical assessment of the results of clinical trials of ACE inhibitors and ARBs across a variety of clinical conditions and assesses the potential need for new methods for blocking the renin system, including the use of renin inhibitors. © 2007 MedReviews, LLC DOWNLOAD POWERPOINT FIGURES @ www.medreviews.com he development of effective inhibitors of the renin-angiotensin system (RAS) has represented a major step forward in the treatment of hypertension and cardiovascular diseases. Based on experimental and clinical studies using angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), we now know that RAS activity may be a key factor in the pathophysiology and development of hypertension, renal disease, atherosclerosis, diabetes, and heart failure in a substantial number of patients.1,2 T 30 VOL. 1 NO. 1 2007 REVIEWS FOR PRIMARY CARE http://www.medreviews.com
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