Renin–angiotensin system blockade and reduction of cardiovascular risk: future perspectives

Treatment with renin-angiotensin system blockers (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) has shown clear benefits in distinct stages of cardiovascular disease. These treatments lower blood pressure and prevent the appearance of markers of subclinical disease (such as microalbuminuria), reduce cardiovascular and renal events in patients with subclinical lesions, and prolong survival in patients with clinical disease or organ dysfunction. Despite this unquestionable benefit, the residual risk in patients receiving these treatments often continues to be high and, consequently, strategies to reduce such risk are required. The present article reviews options that may help to reduce cardiovascular disease in such patients. They include efforts of primary prevention in healthy individuals, stricter therapeutic goals, comprehensive risk control, a more complete blocking of the renin-angiotensin system and the use of combinations of drugs with synergistic protective mechanisms.