Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2010, vol. 19, nr 3, May-June, p. 389–398

Publication type: review article

Language: English

Future Potential Indications for Pharmacotherapy Using Renin–Angiotensin–Aldosterone System Inhibitory Agents

Nowe potencjalne wskazania do farmakoterapii lekami blokującymi układ RAA

Łukasz Dobrek1,, Piotr J. Thor1,

1 Chair and Department of Pathophysiology, Medical College, Jagiellonian University, Kraków, Poland

Abstract

The renin–angiotensin–aldosterone system (RAAS) plays a key role in the pathogenesis of many disorders, including heart failure, coronary artery disease, hypertension, kidney disorders, and diabetic vascular complications. Thus RAAS inhibition using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) has become a standard pharmatherapeutic procedure in these clinical entities. Moreover, there are also reports suggesting additional possibilities of ACEI or ARB therapy. Beneficial clinical effects after ACEI or ARB administration were observed in various disturbances, including atherosclerosis, atrial fibrillation, Alzheimer’s disease, post-ischemic stroke state, portal and pulmonary hypertension, and neoplastic disorders. It seems that in the near future these agents may be recommended to inhibit the RAAS in the course of the above clinical entities. However, further studies are required to establish their place in the pharmacotherapy and new potential indications. This article briefly describes the legitimacy of ACEI or ARB treatment of these diseases.

Streszczenie

Układ renina–angiotensyna–aldosteron (RAA) odgrywa znaczną rolę w patogenezie wielu chorób, takich jak: niewydolność serca, choroba wieńcowa, nadciśnienie tętnicze, choroby nerek lub powikłania cukrzycy. Blokada układu RAA za pomocą inhibitorów konwertazy angiotensyny (ACEI) lub leków blokujących receptory angiotensyny (ARB) jest zatem obecnie standardowym postępowaniem terapeutycznym w tych chorobach. Istnieje coraz więcej doniesień o potencjalnych dodatkowych wskazaniach do farmakoterapii lekami z grup ACEI lub ARB. Korzystne wyniki kliniczne obserwowano również podczas leczenia miażdżycy, migotania przedsionków, choroby Alzheimera, stanów po udarze mózgu, nadciśnienia płucnego, nadciśnienia wrotnego oraz niektórych chorób nowotworowych. Wiele wskazuje na to, iż w przyszłości ACEI lub ARB będą również lekami rekomendowanymi do leczenia chorób wymienionych wyżej. Trwają wciąż badania kliniczne mające na celu jednoznaczne ustalenie ich korzystnego działania i roli w farmakoterapii wspomnianych zaburzeń. Artykuł krótko przedstawia zasadność stosowania leków z grupy ACEI lub ARB w leczeniu chorób innych niż ich dotychczasowe wskazania.

Key words

rennin–angiotensin–aldosterone system (RAAS), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), ACEI and/or ARB novel pharmacotherapy

Słowa kluczowe

układ renina–angiotensyna–aldosteron (RAA), inhibitory konwertazy angiotensyny (IKA; ACEI), blokery receptora angiotensyny (ARB), nowoczesna farmakoterapia ACEI/ARB

References (40)

  1. Zaman MA, Oparil S, Calhoun DA: Drugs targeting the renin-angiotensin-aldosterone system. Nat Rev Drug Discov 2002, 1, 621–636.
  2. Brewster UC, Parazella MA: The renin–angiotensin–aldosterone system and the kidney: effects on kidney disease. Am J Med 2004, 116, 263–272.
  3. Perazella MA, Setaro JF: Renin–angiotensin–aldosterone system: fundamental aspects and clinical implications in renal and cardiovascular disorders. J Nucl Cardiol 2003, 10, 184–196.
  4. Stanton A: Review: Potential of renin inhibition in cardiovascular disease. J Renin Angiotensin Aldosterone Syst 2003, 4, 6–10.
  5. Fabiani ME, Johnston CI: Spectrum of use for the angiotensin-receptor blocking drugs. Curr Hyperten Rep 1999, 1, 394–401.
  6. Unger T, Li J: The role of the renin–angiotensin–aldosterone system in heart failure. J Renin Angiotensin Syst 2004, 5 (Suppl. 1), S7–S10.
  7. Swedberg K: Conclusions on the management of heart failure. J Renin Angiotensin Syst 2004, 5, Supp. 1, S34– S36.
  8. Metra M, Nodari S, Dei Cas L: Current guidelines in the pharmacological management of chronic heart failure. J Renin Angiotensin Syst 2004, 5 (Suppl. 1), S11–S16.
  9. Struthers AD: Aldosterone blockade in heart failure. Journal Renin Angiotensin Syst 2004, 5, Suppl. 1, S23–S27.
  10. McMurray J: Angiotensin inhibition in heart failure. J Renin Angiotensin Syst 2004, 5, Suppl. 1, S17–S22.
  11. O’Keefe JH, Lurk JT, Kahatapitiya RC, Haskin JA: The renin–angiotensin–aldosterone system as a target in coronary disease. Curr Atheroscler Rep 2003, 5, 124–130.
  12. Lefebvre HP, Toutain PL: Angiotensin converting enzyme inhibitors in the therapy of renal diseases. J V et Pharmacol Therap 2004, 27, 265–281.
  13. Karalliedde J, Viberti G: Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes. J Hum Hypertens 2006, 20, 239–253.
  14. Cooper ME: The role of the renin-angiotensin-aldosterone system in diabetes and its vascular complications. Am J Hypertens 2004, 17, 16S–20S.
  15. Hanes D, Nahar A, Weir MR: The tissue renin–angiotensin–aldosterone system in diabetes mellitus. Curr Hypertens Rep 2004, 6, 98–105.
  16. Giacchetti G, Sechi LA, Rilli S, Carey RM: The renin–angiotensin–aldosterone system, glucose metabolism and diabetes. Trends Endocrinol Metab 2005, 16, 120–126.
  17. Halkin A, Keren G: Potential indications for angiotensin converting enzyme inhibitors in atherosclerotic vascular disease. Am J Med 2002, 112, 126–134.
  18. Higgins JP: Can angiotensin converting enzyme inhibitors reverse atherosclerosis? South Med J 2003, 96, 569–579.
  19. Duprez DA: Role of the renin–angiotensin–aldosterone system in vascular remodeling and inflammation: a clinical study. J Hypertens 2006, 24, 983–991.
  20. Finkielstein D, Schweitzer P: Role of angiotensin converting enzyme inhibitors in the prevention of atrial fibrillation. Am J Cardiol 2004, 93, 734–736.
  21. Wachtell K, Devereux RB, Lyle PA: Use of beta blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers to prevent atrial fibrillation. Curr Cardiol Rep 2006, 8, 356–364.
  22. Murray K, Mace LC, Yang Z: Nonantiarrhythmic drug therapy for atrial fibrillation. Heart Rhythm 2007, 4, S88– S90.
  23. Freestone B, Beevers DG: The renin–angiotensin–aldosterone system in atrial fibrillation: a new therapeutic target? J Hum Hypertens 2004, 18, 461–465.
  24. Savelieva I, Camm J: Is there any hope for angiotensin-converting enzyme inhibitors in atrial fibrillation? Am Heart J 2007, 154, 403–406.
  25. Healey JS, Morillo CA, Connolly SJ: Role of the renin–angiotensin–aldosterone system in atrial fibrillation and cardiac remodeling. Curr Opin Cardiol 2004, 20, 31–37.
  26. Dorian P: The future of atrial fibrillation therapy. J Cardiovasc Electrophysiol 2006, 17, Suppl. 2, S11–S16.
  27. Madrid AH, Marin I, Cervantes CE, Morell EB, Estevez JE, Moreno G, Parajon JR, Peng J, Limon L, Nannini S, Moro C: Prevention of recurrence in patients with lone atrial fibrillation. The dose-dependent effect of angiotensin II receptor blockers. Journal Renin Angiotensin Syst 2004, 5, 114–120.
  28. Culman J, Baulmann J, Blume A, Unger T: The renin-angiotensin system in the brain: an update. J Renin Angiotensin Syst 2001, 2, 96–102.
  29. Llorens-Cortes C, Mendelsohn FAO: Organisation and functional role of the brain angiotensin system. J Renin Angiotensin Syst 2002, 3, Suppl. 1, S39–S48.
  30. Hajjar IM, Keown M, Lewis P, Almor A: Angiotensin converting enzyme inhibitors and cognitive and functional decline in patients with Alzheimer’s disease: an observation study. Am J Alzheimers Dis Other Demen 2008, 23, 77–83.
  31. Kehoe PG: Review: The renin–angiotensin–aldosterone system and Alzheimer’s disease? J Renin Angiotensin Syst 2003, 4, 80–93.
  32. Sokol SI, Portnay EL, Curtis JP, Nelson MA, Hebert PR, Sctaro JF, Foody JM: Modulation of the renin–angiotensin– aldosterone system for the secondary prevention of stroke. Neurology 2004, 63, 208–213.
  33. Pelegrini-Da-Silva A, Martins AR, Prado WA: A new role for the renin–angiotensin system in the rat periaqueductal gray matter: angiotensin receptor-mediated modulation of nociception. Neuroscience 2005, 132, 453–463.
  34. Simon K: Diagnostyka i leczenie nadciśnienia wrotnego ze szczególnym uwzględnieniem metod endoskopowych. Przegl Epidemiol 2006, 60, 715–724.
  35. Vlachogiannakos J, Tang AKW, Patch D, Burroughs AK: Angiotensin converting enzyme inhibitors and angiotensin II antagonists as therapy in chronic liver disease. Gut 2001, 49, 303–308.
  36. Nasr AA, Gad El-Hak N, Settein ME, Khafagy MA, Tadros MTY: Effects of angiotensin converting enzyme inhibitors and sclerotherapy on portal hemodynamics in patients with portal hypertension. Hepatogastroenterology 2000, 47, 795–806.
  37. Ramalho FS, Ramalho LNZ, Castro-e-Silva O, Zucoloto S, Correa FMA: Effect of angiotensin converting enzyme inhibitors on liver regeneration in rats. Hepatogastroenterology 2002, 49, 1347–1351.
  38. Jeffery TK, Wanstall JC: Pulmonary vascular remodeling: a target for therapeutic intervention in pulmonary hypertension. Pharmacol Ther 2001, 92, 1–20.
  39. Morrell NW, Morris KG, Stenmark KR: Role of angiotensin converting enzyme and angiotensin II in development of hypoxic pulmonary hypertension. Am J Physiol 1995, 269, H1186–H1194.
  40. Lindberg H, Nielsen D, Jensen BV, Eriksen J, Skovsgaard T: Angiotensin converting enzyme inhibitors for cancer treatment? Acta Oncol 2004, 43, 142–152.