BLOCKING OF RENIN-ANGIOTENSIN -ALDOSTERONE SYSTEM: MESSAGE FROM LARGE CLINICAL STUDIES

Hypertension is one of the most common worldwide diseases afflicting humans. Multiple factors modulate the blood pressure for adequate tissue perfusion and include humoral mediators, vascular reactivity, circulating blood volume, vascular caliber, blood viscosity, cardiac output, blood vessel elasticity, and neural stimulation. These changes can lead to the development of left ventricular hypertrophy, systolic and diastolic LV dysfunction, coronary artery disease, cardiac arrhythmias and heart failure. A lot of studies such as HOPE, EUROPA, VALUE, RESOLVD, LIFE, in the last 20 years tested the effects of angiotensin converting enzyme inhibitors and angiotensin-1-receptor blokers in patients with hypertension associated with left ventricular hypertrophy, and coronary disease. Both angiotensin-converting enzyme inhibitors and angiotensin-1-receptor blokers, effectively inhibit the renin-angiotensin-aldosterone system, but they do so by affecting different parts of the cascade. Several angiotensin-1-receptor blokers (losartan, valsartan, candesartan) have shown to be similarly potent when compared to angiotensin converting enzyme inhibitors in reducing mortality in heart failure patients as well as after acute myocardial infarction; this has been proven in several trials, such as ELITE II, VALHEFT, CHARM and ONTARGET. Nowadays, with the aim to achieve the total blockage of renin-angiotensin-aldosterone system, a new group of drugs aldosterone receptor antagonist is used.