The past, present and future of renin-angiotensin aldosterone system inhibition

Robert J. Mentz*, George L. Bakris, Bernard Waeber, John J.V. McMurray, Mihai Gheorghiade, Luis M. Ruilope, Aldo P. Maggioni, Karl Swedberg, Ileana L. Piña, Mona Fiuzat, Christopher M. O'Connor, Faiez Zannad, Bertram Pitt

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

107 Scopus citations

Abstract

The renin-angiotensin aldosterone system (RAAS) is central to the pathogenesis of cardiovascular disease. RAAS inhibition can reduce blood pressure, prevent target organ damage in hypertension and diabetes, and improve outcomes in patients with heart failure and/or myocardial infarction. This review presents the history of RAAS inhibition including a summary of key heart failure, myocardial infarction, hypertension and atrial fibrillation trials. Recent developments in RAAS inhibition are discussed including implementation and optimization of current drug therapies. Finally, ongoing clinical trials, opportunities for future trials and issues related to the barriers and approvability of novel RAAS inhibitors are highlighted.

Original languageEnglish (US)
Pages (from-to)1677-1687
Number of pages11
JournalInternational Journal of Cardiology
Volume167
Issue number5
DOIs
StatePublished - Sep 1 2013

Funding

G.L.B. is a consultant to Takeda, Abbott, Novartis, Fibrogen, and Diachi Sankyo; and investigator initiated funding from Medtronic, Relapsya, Forest, and Takeda. B.W. received lectures fees and/or serves as a member of speakers' bureaus of Servier, Menarini, Novartis, Pfizer, and AstraZeneca. J.J.V.M. received lecture fees from AstraZeneca and has received research support from Amgen and Johnson & Johnson/Scios. M.G. is a consultant for Abbott, Astellas, AstraZeneca, Bayer Schering, Cardiorentis, CorThera, Cytokinetics, CytoPherx, DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Intersection Medical, JNJ, Medtronic, Merck, Novartis, Ono Parmaceuticals, Otsuka, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay, Sticares InterACT, Takeda Pharmaceuticals and Trevena Therapeutics. A.P.M. has consulted for Novartis and has received honoraria from Otsuka. K.S. receives research grants from AstraZeneca, Servier, and Amgen; honoraria from AstraZeneca, Otsuka, Servier, and Amgen; and is a consultant for Cytokinetics, Servier, and Novartis. I.L.P. receives research grants from NIH, serves as a member of speakers' bureaus of Novartis, Otsuka, and as a consultant to the US Food and Drug Administration, GE Healthcare, Novartis, and advisory board for BG-Medicine. F.Z. has received honoraria from and served on advisory boards for Pfizer. B.P. is a consultant to Pfizer, Merck, Novartis, Takeda, Astra Zeneca, Bayer, Lilly, BMS, Cytopherx, Amorcyte, Relypsa, BG-Medicine, Aurasense, and GE-Health Care; stocks options in Relypsa, BG-Medicine, and Aurasense; and grants from Novartis, Forrest Laboratories, and Medtronic. The other authors report no relevant conflicts of interest related to this work.

Keywords

  • Clinical trials
  • Heart failure
  • Hypertension
  • Myocardial infarction
  • Renin-angiotensin aldosterone system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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