Renin-Angiotensin-Aldosterone System Inhibitors for Cardiovascular Disease Management

Introduction to RAAS Inhibitors

The European Society of Cardiology recommends RAAS inhibitors as cornerstone treatments for cardiovascular diseases due to their proven mortality and morbidity benefits 1, 2

Angiotensin II is the principal pressor agent of the renin-angiotensin system, causing vasoconstriction, stimulation of aldosterone synthesis and release, cardiac stimulation 5
The American College of Cardiology suggests that ACEIs prevent the formation of angiotensin II from angiotensin I, while MRAs block aldosterone's effects at the receptor level 1, 4

RAAS inhibitors are recommended for heart failure with reduced ejection fraction (HFrEF) - Class IA recommendation, arterial hypertension, coronary artery disease, post-myocardial infarction, left ventricular hypertrophy, and diabetic nephropathy and chronic kidney disease 1, 2
The European Heart Society indicates that RAAS inhibitors provide mortality and morbidity benefits through limiting cardiac and vascular remodeling, reducing oxidative stress in the vasculature, improving endothelial function, and decreasing fibrosis and inflammation 1, 4, 5

Hyperkalaemia is a common side effect, especially in patients with advanced chronic kidney disease, heart failure, or when using dual RAAS inhibition 1, 2
Angioedema is a rare but serious side effect, more common with ACEIs than ARBs 4

The European Society of Cardiology recommends initiating an ACEI (or ARB if ACEI intolerant) before adding an MRA for heart failure patients, and implementing an MRA before diagnosing true resistant hypertension 1
Loop diuretics can be used to manage hyperkalemia in patients on RAAS inhibitors, and RAAS inhibitors attenuate potassium loss caused by thiazide diuretics 1, 4