Dual Blocking of the Renin Angiotensin System

The renin angiotensin system (RAS) plays an all-encompassing role in cardiovascular regulation. Indeed, the early notion defining its function as vasoconstrictive was expanded to a much broader physiological spectrum, including sodium regulation and structural cardiovascular changes. Moreover, many studies have shown the synthesis and release of various components of the RAS in a number of organs.Further research revealed disparate RAS effects on vascular tone and sodiumexcretion. That is, RAS can induce vasoconstriction or vasodilatation, natriuresis or sodium retention, hypertrophy or decreased proliferation, all depending on a diversity of angiotensin peptides that can bind to different receptors. The complexity of this system explains the multiplicity of its effects.

Predictably, inhibition of RAS at various levels potentially could yield multiple benefits. Indeed, treatments with either angiotensin converting enzyme inhibitors (ACEi), or angiotensin II receptor blockers (ARB’s) have shown important beneficial effects, many of which are independent from hypertension control. Actually, RAS inhibition is effective not only in treating essential hypertension, but also in renovascular hypertension, heart failure, diabetic nephropathy, various kidney diseases, (particularly when associated to heavy proteinuria), atherosclerosis, acute coronary syndrome, vasculitis, ventricular hypertrophy, atrial fibrillation, insulin resistance, multiple sclerosis and others. Progression in most of these conditions is linked to RAS pathobiological effects. Read more......................