Interv Akut Kardiol. 2010;9(5):252-257

Renin-angiotensin system blockade in treating cardiovascular disease

Jindřich Špinar¹, Jiří Vítovec²

¹ Interní kardiologická klinika FN Brno, Brno

² I. interní kardioangiologická klinika FN u sv. Anny, Brno

Current knowledge on renin-angiotensin-aldosterone system and the options of its blockade are summarized. Blockade at the level of

converting enzyme (ACE inhibitors = ACE-I) and at the level of receptor (AT1 blockers = ARB) has been an established treatment modality

in numerous cardiovascular diseases, particularly heart failure, post myocardial infarction, hypertension or diabetes mellitus. Comparison

of ACE inhibitors and AT1 blockers was initially performed in heart failure and post myocardial infarction in the ValHeft and VALIANT trials,

respectively; and, subsequently, in secondary prevention of ischemic heart disease in the ONTARGET trial, with all these trials showing

equality of both drug groups. Aliskiren, a direct renin blocker that blocks renin at the level of conversion of angiotensinogen to angiotensin

I, is in phase III–IV of clinical trials. This agent is tested in the extensive ASPIRE HIGHER program in the same indications in which

ACE-I or ARB are administered. In 2009, we reported on three large clinical trials – AVOID in diabetic proteinuria, ALLAY in left ventricular

hypertrophy in hypertension and ALLOFT in heart failure. This paper deals with AGELESS, another large trial comparing aliskiren and

ramipril in geriatric patients with systolic hypertension.

Keywords: renin, angiotensin, heart failure, ischemic heart disease, aliskiren

Published: November 30, 2010  Show citation