Authors: Jankowski, P.; Safar, M. E.; Benetos, A.

Source: Current Pharmaceutical Design, Volume 15, Number 5, February 2009 , pp. 571-584(14)

Publisher: Bentham Science Publishers

Abstract:

The renin-angiotensin-aldosterone system blockade is a key component in the modern management of cardiovascular diseases. Agents that interfere with the different components of this system such as angiotensin converting enzyme inhibitors, sartans and mineralocorticoid receptor antagonists represent valuable therapeutic tools to reduce cardiovascular risk in brachial blood pressure independent mechanisms. Indeed, antagonists of the renin-angiotensin-aldosterone system reduce inflammation, oxidative stress and vascular remodeling in hypertension beyond blood pressure reduction and have demonstrated better cardiovascular protection compared with some of the other antihypertensive agents, especially in selected populations such as patients with diabetes and renal failure. These advantages were confirmed recently in several large-scale randomized trials. Latest evidence suggests that the effect of some antihypertensive drugs on central blood pressure is greater when compared with the effect on peripheral pressure. Nowadays, there is growing agreement that relatively greater influence of agents blocking renin-angiotensin system on central blood pressure may at least partly explain their advantages over other antihypertensives in many clinical situations. Clinical consequences of overestimation of the antihypertensive effect of some drug classes and underestimation blood pressure changes in patients treated with angiotensin converting enzyme inhibitors when analyzing brachial instead of central blood pressure is being increasingly recognized recently.

Keywords: Renin-angiotensin-aldosterone system; angiotensin converting enzyme inhibitors; sartans; mineralocorticoid receptor antagonists; hypertension; central blood pressure; cardiovascular risk; pleiotropic effects

Document Type: Research article

DOI: http://dx.doi.org/10.2174/138161209787315747

Affiliations: 1: 1st Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Publication date: 2009-02-01

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• Current Pharmaceutical Design publishes timely in-depth reviews covering all aspects of current research in rational drug design. Each issue is devoted to a single major therapeutic area. A Guest Editor who is an acknowledged authority in a therapeutic field has solicits for each issue comprehensive and timely reviews from leading researchers in the pharmaceutical industry and academia.
  
  Each thematic issue of Current Pharmaceutical Design covers all subject areas of major importance to modern drug design, including: medicinal chemistry, pharmacology, drug targets and disease mechanism.

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