The renin-angiotensin-aldosterone system: a crossroad from arterial hypertension to heart failure.
The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in the regulation of blood pressure and volume homeostasis, promoting critical structural changes in every component of the cardiovascular system, including the heart and blood vessels. Consequently, the RAAS is a crucial therapeutic target for several chronic diseases of the cardiovascular system, spanning from arterial hypertension (AH) to heart failure (HF). AH represents a leading risk factor for the development of symptomatic HF, particularly with left ventricle (LV) preserved ejection fraction (HFpEF). LV diastolic dysfunction and cardiac remodelling are the first discernible manifestations of heart disease in patients with AH. Typically, AH develops many years before the diagnosis of overt HF, providing a therapeutic target for preventive strategies. Treatment of AH is based on different classes of antihypertensive drugs, which show differences in their capacity to prevent the evolution towards HF. The blockers of the RAAS are effective drugs to treat AH and prevent HF with reduced ejection fraction (HFrEF), but the evidence of the potential benefits in patients with HFpEF remains limited. In this review, the authors summarise data from several clinical trials of HFpEF and HFrEF, focusing on the mechanisms leading the transition from AH to HF and late complications.
['Pugliese|Nicola Riccardo|NR|http://orcid.org/0000-0002-5473-227X', 'Masi|Stefano|S|', 'Taddei|Stefano|S|']
D057911:Angiotensin Receptor Antagonists D000806:Angiotensin-Converting Enzyme Inhibitors D000959:Antihypertensive Agents D001794:Blood Pressure D006333:Heart Failure D006801:Humans D006973:Hypertension D000451:Mineralocorticoid Receptor Antagonists D016032:Randomized Controlled Trials as Topic D012084:Renin-Angiotensin System D013318:Stroke Volume
Renin-angiotensin-aldosterone system Arterial hypertension Heart failure Preserved ejection fraction