Nephrological approach to the blockade of the renin-angiotensin for treating hypertension

Abstract

The renin-angiotensin system plays a key role in the regulation of blood pressure, and blockade of this system now forms a central part of strategies to reduce the risk for cardiovascular events in hypertensive patients, namely in those with renal disease and high risk. Blockade of the renin-angiotensin system with angiotensin converting enzyme inhibitors or angiotensin II type 1 receptor antagonists has proved effective in the treatment of hypertensive patients with or without renal disease, thus providing first-line therapy in the nephrological setting. Studies comparing the two classes of have shown that they appear to have similar efficacy though angiotensin II type 1 receptor antagonists are better tolerated. Although previous studies found that combinations of these two classes of drugs have greater antihypertensive and renoprotective effects than monotherapy, data from recent large trials suggest that combination therapy may be detrimental, namely in terms of renal complications.