Renin – angiotensin system (RAS) and hypertensive disease"From the link in pathophysiology to the outcomes of inhibition"

SUMMARY The renin angiotensin system is a major contributor to both hypertension and associated pathophysiologic changes in the heart and cardiovascular wall (The target organ). Major basic and clinical trials have shown that ACE inhibitor and ARB are the main renin- angiotensin system blockers in use assist in controlling hypertension and reducing target organ damage, thus they should be used as a first-line treatment for hypertension. Moreover, ARBs specifically reduces the frequency of atrial fibrillation and stroke, thus it has emerged as a new preventive and therapeutic strategy for these conditions. In theory, combining ACE inhibitor and ARBs maximizes benefits because it offers more complete RAS blockage but this expectation was not confirmed by most recent clinical trials and was not translated into real patients benefits. Renin inhibition was introduced as a better step for reducing angiotensin II, because it offer complete blockage of the whole system. Early studies confirmed that renin inhibitors reduced blood pressure better than ACE inhibitors but further large clinical trials have been started and therefore in the near future, further clinical evidences will be available to confirm the antihypertensive, anti-inflammatory and antiatherosclerotic effects of renin inhibitor. List of abbreviations: RAS (renin angiotensin system), ACE (angiotensin converting enzyme), ARB (angiotensin receptor blocker), AT1 (angiotensin II receptor type 1), AT2 (angiotensin II receptor type 2), AT4 (angiotensin II receptor type 4), LVH (Left ventricular hypertrophy), AF (atrial fibrillation), CCF (Congestive heart failure).