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Curr Hypertens Rep. 2010 Apr;12(2):67-73. doi: 10.1007/s11906-010-0091-9.

The evolution of renin-angiotensin blockade: angiotensin-converting enzyme inhibitors as the starting point.

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  • 1Clinical Pharmacology and Hypertension, Virginia Commonwealth University Health System, Sanger Hall, Room 8-062, Richmond, VA 23298-0160, USA.


The renin-angiotensin system has been a target in the treatment of hypertension for close to three decades. Several medication classes that block specific aspects of this system have emerged as useful therapies, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and, most recently, direct renin inhibitors. There has been a natural history to the development of each of these three drug classes, starting with their use as antihypertensive agents; thereafter, in each case they have been employed as end-organ protective agents. To date, there has been scant evidence to favor angiotensin receptor blockers or direct renin inhibitors over angiotensin-converting enzyme inhibitors in treating hypertension or in affording end-organ protection; thus, angiotensin-converting enzyme inhibitors remain the standard of care when renin-angiotensin system blockade is warranted.

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