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

Abstract

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.

Keywords::

• cardiorenal continuum
• cardiovascular disease
• prevention
• renin–angiotensin system
• residual risk
• silent organ damage

Financial & competing interests disclosure

A de la Sierra has received honoraria for consultancy or participation in scientific meetings funded by Bayer-Schering Pharma, Daiichi-Sankyo, Menarini, Merck-Serono, Novartis and sanofi-aventis. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.