OUTLOOK HEART HEALTH I magine someone cut severely in an accident and losing blood fast. Blood pressure drops dangerously low as blood is lost, and the kidneys react by releasing the enzyme renin. The circulating renin leads to the production of angiotensin II, a hormone that constricts blood vessels and prompts the kidneys to retain more salt and water to prop up the blood pressure. This renin-angiotensin system can save the life of our imagined person as they lay bleeding to death. Under other circumstances, it can kill. Our research reveals that the renin-angiotensin system might be tweaked in novel ways to fight heart disease -but we can only do that accurately and precisely by first learning the exact details of how the system's hormone receptors work.The consequences of activating the renin-angiotensin system depend on the circumstances, and to which receptor the angiotensin II binds. If it binds to the angiotensin AT 1 receptor, the blood pressure-increasing mechanism is engaged. And AT 1 receptor binding under normal circumstances can raise blood pressure and damage the cells of the heart's left ventricle, the chamber that pumps oxygenated blood out of the heart. In addition, clinical studies have shown that drugs that block this receptor can also reduce damage to the heart. Therefore, blocking this receptor serves as a therapeutic strategy for treating cardiovascular diseases, especially hypertension.When drugs for high blood pressure block a receptor docking site for angiotensin II, more of the hormone remains free to circulate in the blood. Increased levels of circulating angiotensin II affect a second receptor, AT 2 . The AT 2 receptor triggers a molecular cascade that expands the size of blood vessels and helps prevent damage to the heart. In essence, the actions triggered by the second receptor are the opposite of the processes caused by the first. In addition, the body makes more AT 2 receptors in response to several pathological conditions, including heart attack, heart failure and stroke. So when things go wrong with the cardiac system, the AT 2 receptor system appears to serve a protective function.Other research results support such a protective role for the AT 2 receptor. In one study, for example, researchers engineered animals with varying amounts of AT 2 receptor and confirmed that it can activate mechanisms that protect the heart 1 (some studies produced conflicting results, possibly due to different receptor production levels in the genetically altered animals). As well as modifying the amount of the receptor, researchers can look for molecules other than angiotensin II that can turn on the AT 2 receptor. Just such a molecule exists, and it's called compound 21 (C21).We and other research groups have tested C21's ability to influence high blood pressure, but surprisingly C21 has no effect on the condition 2 . Nonetheless, our results continue to suggest the potential of exploiting this compound's role in repairing an injured heart. For example, C21 reduces stiffness in arteries, an effec...