The renin-angiotensin-aldosterone system in heart failure for the non-specialist: the past, the present and the future

Postgrad Med J. 2017 Jan;93(1095):29-37. doi: 10.1136/postgradmedj-2016-134045. Epub 2016 Sep 26.

Abstract

Heart failure is one of the major public health challenges facing the Western world. Its prevalence is increasing as the population ages and modern techniques are implemented to manage cardiac disease. In response, there has been a sustained effort to develop novel strategies to address the high levels of associated morbidity and mortality. Indeed, agents that target the renin-angiotensin-aldosterone system (RAAS) have transformed the way in which we manage heart failure. Despite this, mortality in heart failure is poorer than in many malignancies and a large burden of morbidity and recurrent hospitalisation remains. Here, we review the role of RAAS modulation within the field of systolic heart failure. In particular, we provide practical guidance on using current RAAS blockade agents and focus on the recent emergence of new agents that promise additional substantial benefit to those living with left ventricular systolic dysfunction.

Keywords: Angiotensin converting enzyme inhibitors; Angiotensin receptor and neprilysin inhibitor; Beta-blockers; Mineralocorticoid receptor antagonists; Renin-angiotensin-aldosterone system.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aminobutyrates / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Biphenyl Compounds
  • Drug Combinations
  • Heart Failure / drug therapy*
  • Heart Failure / metabolism
  • Humans
  • Mineralocorticoid Receptor Antagonists / therapeutic use*
  • Neprilysin / antagonists & inhibitors*
  • Renin-Angiotensin System*
  • Tetrazoles / therapeutic use
  • Valsartan
  • Ventricular Dysfunction, Left / drug therapy*
  • Ventricular Dysfunction, Left / metabolism

Substances

  • Adrenergic beta-Antagonists
  • Aminobutyrates
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Biphenyl Compounds
  • Drug Combinations
  • Mineralocorticoid Receptor Antagonists
  • Tetrazoles
  • Valsartan
  • Neprilysin
  • sacubitril and valsartan sodium hydrate drug combination