The RAS: A Primary Target for Cardiovascular Disease Prevention

By King, Deborah S; Wofford, Marion R; Stewart, Jimmy L | Drug Topics, November 4, 2002 | Go to article overview

The RAS: A Primary Target for Cardiovascular Disease Prevention


King, Deborah S; Wofford, Marion R; Stewart, Jimmy L, Drug Topics


Continuing Education

Wyeth

TRENDS IN PHARMACY AND PHARMACEUTICAL CARE

An ongoing CE program of

The University of Mississippi School of Pharmacy and DRUG TOPS

Cardiovascular disease (CVD) remains the leading cause of death in the United States. Activation of the reninangiotensin system (RAS) plays a central role in the development and progression of CVD with the deleterious effects of angiotensin II increasingly being recognized. Disruption of the RAS offers considerable promise for treatment as well as prevention of cardiovascular disorders, including protection against the vascular and cardiac structural changes that precipitate adverse events. Angiotensin-converting enzyme (ACE) inhibitors were initially developed for use in the management of hypertension. Since the introduction of these agents for hypertension management, clinical trials have demonstrated quite conclusively that ACE inhibitors provide important advantages for preventing CVD progression. ACE inhibitors have received additional clinical indications and have become the treatment standard for several disease states. The beneficial effect of RAS blockage with ACE inhibitors is well recognized in the areas of heart failure; myocardial infarction; renal disease; and, most recently, stroke. ACE inhibitors decrease mortality in congestive heart failure and left ventricular dysfunction after myocardial infarction. ACE inhibitors also delay the progression of renal disease, including diabetic nephropathy, and reduce the risk of stroke as well as the degree of functional impairment post-stroke. Results from the landmark Heart Outcomes Prevention Evaluation (HOPE) study have changed widespread views about how hypertension and those at risk for CVD should be treated.

The use of ACE inhibitors for CVD management and comparisons with angiotensin receptor blockers have been explored in earlier issues. The focus of this article will be on the expanding knowledge of the RAS, current understanding of the endothelium and endothelial dysfunction in CVD pathogenesis, and emerging roles for ACE inhibitors for primary prevention of CVD. Expanding knowledge of the HAS Beginning with the discovery of renin in 1898, the characterization and differentiation of the RAS has evolved over the past 100 years. The finding that Bothrops jararaca (Brazilian pit viper) venom peptides preserve or potentiate the effects of bradykinin was followed by the development of synthetic peptides and then the first orally active ACE inhibitors almost 25 years ago. An explosion in CVD research has accompanied these advances in RAS understanding. More has been learned about the RAS in the last decade than in the preceding 90 years.

Initial research efforts with ACE inhibitors focused on their use in hypertension, but they quickly expanded to heart failure; diabetes; and, most recently, stroke prevention. Since the introduction of captopril, with approval only for severe hypertension unresponsive to other agents, a remarkable turnabout has occurred. The benefits of ACE inhibitors have been confirmed in many largescale randomized clinical trials. ACE inhibitors are now included among the medications recommended for initial monotherapy for hypertension by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) for patients with a variety of comorbid conditions.

As the role of ACE inhibitors has developed in clinical use, special benefits beyond those provided by other agents have been recognized. It has also been importantly recognized that correcting blood pressure alone is not sufficient for CVD risk reduction. The strategy prescribed should also have the potential to prevent later cardiovascular morbid events, including heart failure, kidney failure, or stroke that shortens the useful life of a person with hypertension. The benefits of ACE inhibitors are clear in the relieving of acute and chronic heart failure, the preventing of remodeling and progressive ventricular dysfunction after myocardial infarction, and the slowing of glomerular sclerosis in diabetic and other nephropathies. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The RAS: A Primary Target for Cardiovascular Disease Prevention
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.