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Prim Care. 2014 Dec;41(4):765-78. doi: 10.1016/j.pop.2014.08.002. Epub 2014 Sep 29.

Renin-angiotensin-aldosterone system inhibition: overview of the therapeutic use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and direct renin inhibitors.

Author information

1
Botsford Hospital, 28050 Grand River Avenue, Farmington Hills, MI 48336, USA.
2
Garden City Hospital, 6245 N. Inkster Road, Garden City, MI 48135, USA.
3
Garden City Hospital, 6245 N. Inkster Road, Garden City, MI 48135, USA; Hypertension Nephrology Associates, PC, 18302 Middlebelt Road, Livonia, MI 48152, USA. Electronic address: jibieder@me.com.

Abstract

Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy in hypertensive diabetic patients with macroalbuminuria, microalbuminuria, or normoalbuminuria has been repeatedly shown to improve cardiovascular mortality and reduce the decline in glomerular filtration rate. Renin-angiotensin-aldosterone system (RAAS) blockade in normotensive diabetic patients with normoalbuminuria or microalbuminuria cannot be advocated at present. Dual RAAS inhibition with ACE inhibitors plus ARBs or ACE inhibitors plus direct renin inhibitors has failed to improve cardiovascular or renal outcomes but has predisposed patients to serious adverse events.

KEYWORDS:

Albuminuria; Aldosterone; Angiotensin; Combination; Diabetes; Kidney disease; Renin; Review

PMID:
25439533
DOI:
10.1016/j.pop.2014.08.002
[Indexed for MEDLINE]

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