Key result
Pharmacological inhibition of the renin-angiotensin system with ACE inhibitors, ARBs, or renin inhibitors reduces atherosclerotic inflammation and improves cardiovascular outcomes beyond blood pressure lowering.
Why the study?
Does pharmacological inhibition of the renin-angiotensin system (ACE inhibitors, ARBs, and renin inhibitors) improve inflammatory processes governing atherosclerosis and cardiovascular prognosis in patients with cardiovascular disease?
Does pharmacological inhibition of the renin-angiotensin system (ACE inhibitors, ARBs, and renin inhibitors) improve inflammatory processes governing atherosclerosis and cardiovascular prognosis in patients with cardiovascular disease?
This review highlights the role of the renin-angiotensin system as a proinflammatory mediator in atherosclerosis and supports its pharmacological inhibition to improve cardiovascular prognosis independent of blood pressure lowering.
Answers are grounded in this paper and cite their sources.
Supports pleiotropic vascular protection with RAS inhibitors beyond BP lowering; leaves open prospective trials isolating anti-inflammatory effects.
Recent evidence shows that the renin-angiotensin system is a crucial player in atherosclerotic processes. The regulation of arterial blood pressure was considered from its first description of the main mechanism involved. Vasoconstriction (mediated by angiotensin II) and salt and water retention (mainly due to aldosterone) were classically considered as pivotal proatherosclerotic activities. However, basic research and animal studies strongly support angiotensin II as a proinflammatory mediator, which directly induces atherosclerotic plaque development and heart remodeling. Furthermore, angiotensin II induces proatherosclerotic cytokine and chemokine secretion and increases endothelial dysfunction. Accordingly, the pharmacological inhibition of the renin-angiotensin system improves prognosis of patients with cardiovascular disease even in settings of normal baseline blood pressure. In the present review, we focused on angiotensin-convertingenzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and renin inhibitors to update the direct activities of the renin-angiotensin system in inflammatory processes governing atherosclerosis.
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Montecucco et al. (2009) conducted a review in Atherosclerosis and cardiovascular disease. Renin-angiotensin system inhibitors (ACE inhibitors, ARBs, and renin inhibitors) was evaluated. Pharmacological inhibition of the renin-angiotensin system with ACE inhibitors, ARBs, or renin inhibitors reduces atherosclerotic inflammation and improves cardiovascular outcomes beyond blood pressure lowering.
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