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Pharmacotherapy

Optimal blockade of the renin–angiotensin–aldosterone system

Inhibition of the renin–angiotensin–aldosterone system (RAAS) is a successful therapy for hypertension, heart failure, and renal insufficiency. Overdosing of RAAS inhibitors is occasionally observed when several agents are used together, and can cause adverse events such as hypotension, hyperkalaemia, and renal failure. We advocate optimal, rather than complete, RAAS blockade.

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References

  1. Makani, H., Bangalore, S., Desouza, K. A., Shah, A. & Messerli, F. H. Efficacy and safety of dual blockade of the renin–angiotensin system: meta-analysis of randomised trials. BMJ 346, f360 (2013).

    Article  Google Scholar 

  2. Oparil, S. et al. Efficacy and safety of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. Lancet 370, 221–229 (2007).

    Article  CAS  Google Scholar 

  3. Fisher, N. D., Danser, A. H., Nussberger, J., Dole, W. P. & Hollenberg, N. K. Renal and hormonal responses to direct renin inhibition with aliskiren in healthy humans. Circulation 117, 3199–3205 (2008).

    Article  CAS  Google Scholar 

  4. Parving, H. H. et al. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N. Engl. J. Med. 358, 2433–2446 (2008).

    Article  CAS  Google Scholar 

  5. European Medicines Agency. European Medicines Agency recommends new contraindications and warnings for aliskiren-containing medicines [online], (2012).

  6. Whitbeck, M. G. et al. Increased mortality among patients taking digoxin—analysis from the AFFIRM study. Eur. Heart J. http://dx.doi.org/10.1093/eurheartj/ehs348.

  7. Juurlink, D. N. et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N. Engl. J. Med. 351, 543–551 (2004).

    Article  CAS  Google Scholar 

  8. Tanimoto, K. et al. Angiotensinogen-deficient mice with hypotension. J. Biol. Chem. 269, 31334–31337 (1994).

    CAS  PubMed  Google Scholar 

  9. Ménard, J., Campbell, D. J., Azizi, M. & Gonzales, M. F. Synergistic effects of ACE inhibition and Ang II antagonism on blood pressure, cardiac weight, and renin in spontaneously hypertensive rats. Circulation 96, 3072–3078 (1997).

    Article  Google Scholar 

  10. Parving, H. H. et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 367, 2204–2213 (2012).

    Article  CAS  Google Scholar 

Download references

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Correspondence to Jürg Nussberger.

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Nussberger, J., Bohlender, J. Optimal blockade of the renin–angiotensin–aldosterone system. Nat Rev Cardiol 10, 183–184 (2013). https://doi.org/10.1038/nrcardio.2013.28

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