Drugs Targeting RAAS in the Treatment of Hypertension and Other Cardiovascular Diseases

Abstract

Drugs with diversifi ed structure and class target the RAAS cascade at various levels. Beginning with the inhibition of renin from the juxtaglomerular cells of the kidney, it extends to the blockade of formation and actions of its principal component, Ang II, and its effector, aldosterone and its synthesis. Although all of them are very effi cacious in combating overactivation of RAAS, ACE inhibitors and ARBs stand out in the armamentarium of RAAS inhibitors. All of them are effective in lowering blood pressure but differ from each other in potency, pharmacokinetic properties and additional pharmacologic actions that are contributed by their unique functional groups. Therapeutic uses of RAAS blockers stem from the dynamics of the complex intertwined downstream signaling molecules that interact to contribute beyond blood pressure control. Thus, some of the ACE inhibitors and ARBs are also indicated in the treatment of heart failure, left ventricular dysfunction following myocardial infarction, and nephropathy in T2DM, reducing the risk of cardiovascular mortality, nonfatal myocardial infarction, and the risk of developing heart failure. Several studies have investigated the dual inhibition of the RAAS in hypertension and heart failure with an outcome of more adverse events without an increase in benefi t. While considering Ang II and aldosterone escape processes during ACE inhibitors and ARBs therapies, RAAS at the base level can be halted using aldosterone receptor antagonists for the management of hypertension and heart failure. InThe opinions expressed herein are those of GJ and do not necessarily refl ect those of the US Food and Drug Administration.

Analytical Interference in Chemiluminescence Assay–Measured Angiotensin I, Angiotensin II, Aldosterone, and Renin

“…Metformin is of particular concern as it is a very commonly used hypoglycemic medication [ 19 ]. Valsartan, spironolactone, and captopril as targeting RAAS drugs were used in the treatment of hypertension [ 20 , 21 ]. Nifedipine as a calcium antagonist is also used to treat hypertension [ 22 ].…”