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ace inhibitor cardiorenal protection

Beverly Giam, David M Kaye, Niwanthi W Rajapakse
Renal dysfunction and heart failure commonly co-exist; it is termed the cardiorenal syndrome (CRS). This combination of renal and cardiac impairment presents a substantial clinical challenge and is associated with adverse prognosis. The pathogenesis of the CRS is complex, including chronic activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, together with reduced renal perfusion. Chronic activation of the RAAS can impair mitochondrial function, and increase mitochondrial derived oxidative stress which in turn can lead to renal injury and sodium and water retention...
August 2016: Heart, Lung & Circulation
Gema Ruiz-Hurtado, Pantelis Sarafidis, María S Fernández-Alfonso, Bernard Waeber, Luis M Ruilope
The development and progression of cardiovascular disease (CVD) and renal disorders are very closely related. In patients with chronic kidney disease (CKD), therapies proven to protect the cardiovascular and renal systems simultaneously are generally used only at low doses or not at all. In particular, patients with CKD who receive angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or mineralocorticoid-receptor antagonists (MRAs) often do not experience complete blockade of the renin-angiotensin-aldosterone system, primarily owing to the risk of hyperkalaemia...
October 2016: Nature Reviews. Cardiology
Thierry H Le Jemtel, Indranee Rajapreyar, Michael G Selby, Brian Payne, David R Barnidge, Natasa Milic, Vesna D Garovic
BACKGROUND: Renal structural alterations have been partially uncovered in cardiorenal syndrome (CRS). Patients with CRS may have evidence of tubular damage, but markers of glomerular damage other than proteinuria have not been thoroughly investigated. The nature of renal damage in CRS may have therapeutic implications, as glomerular damage requires tight blood pressure control and renin-angiotensin-aldosterone system (RAAS) inhibition. The present investigation evaluates patients with CRS type 2 (CRS-2) for direct evidence of glomerular damage as evidenced by the presence of urinary podocin...
April 2015: Cardiorenal Medicine
Paul M McKie, John C Burnett
The natriuretic peptide system (NPS) is intimately involved in cardiorenal homeostasis in health, and dysregulation of the NPS plays an important role in the pathophysiology of heart failure (HF). Indeed, the diuretic, vasorelaxation, beneficial remodeling, and potent neurohumoral inhibition of the NPS support the therapeutic development of chronic augmentation of the NPS in symptomatic HF. Further, chronic augmentation of the protective NPS and in early stages of HF may ultimately prevent the progression of HF and reduced subsequent morbidity and mortality...
February 2015: Current Heart Failure Reports
Cynthia Ritter, Sarah Zhang, Jane L Finch, Helen Liapis, Edu Suarez, Leon Ferder, James Delmez, Eduardo Slatopolsky
BACKGROUND/AIMS: The search for new therapies providing cardiorenal protection in chronic kidney disease (CKD) has led to treatments that combine conventional renin-angiotensin-aldosterone-system inhibitors with other drugs that exhibit potential in disease management. METHODS: In rats made uremic by renal ablation, we examined the effects of addition of the endothelin-A receptor antagonist atrasentan to a previously examined combination of enalapril (angiotensin converting enzyme inhibitor) and paricalcitol (vitamin D receptor activator) on cardiac and renal parameters...
2014: Kidney & Blood Pressure Research
Fabian Halleck, Katharina Schröder, Sven Holleck-Weithmann, Peter Kossmehl, Reinhold Kreutz, Lars Rothermund
OBJECTIVE: The aim of the present study was to compare the preventive impact of treatment with a vasopeptidase inhibitor (VPI) with an angiotensin-receptor blocker (ARB) on left ventricular (LV) function and renal damage in rats with renal failure after 5/6 renal ablation (Nx). METHODS: Rats (n = 15-20, each group) underwent either sham-operation (Sham) or 5/6 renal ablation (Nx). Two additional groups of Nx-animals (groups Nx-VPI and Nx-ARB) were treated with the VPI ilepatril (AVE7688, 30 mg kg(-1) d(-1)) or with the ARB olmesartan (10 mg kg(-1 )d(-1))...
2015: Clinical and Experimental Hypertension: CHE
Arjan J Kwakernaak, Femke Waanders, Maartje C J Slagman, Martin M Dokter, Gozewijn D Laverman, Rudolf A de Boer, Gerjan Navis
OBJECTIVE: Sodium restriction potentiates the efficacy of the rennin-angiotensin-aldosterone system (RAAS)-blockade and improves long-term cardiovascular and renal protection, even independent of the better blood pressure control. The mechanisms underlying the potentiation of cardiorenal protection by sodium restriction are incompletely understood. RAAS-blockade with angiotensin-converting enzyme (ACE) inhibitors increases circulating levels of the anti-inflammatory and antifibrotic peptide N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP), which is assumed to contribute to its therapeutic effects...
December 2013: Journal of Hypertension
Su-Ching Yang, Hsin-Yi Yang, Yi-Ching Yang, Hsiang-Chi Peng, Pei-Yin Ho
PURPOSE: Hypertension is one of the main factors causing cardiovascular diseases. The aim of the study is to investigate the effects of Chlorella pyrenoidosa on blood pressure and cardiorenal remodeling in rats with N (ω)-nitro-L-arginine methyl ester hydrochloride (L-NAME)-induced endothelial dysfunction. METHODS: Rats were fed a diet containing L-NAME (40 mg/kg) with or without chlorella (4 or 8 %) for 5 weeks. We found that chlorella retarded the development of hypertension and cardiorenal remodeling during the 5-week experimental period...
March 2013: European Journal of Nutrition
Ivana Vaněčková, Petr Kujal, Zuzana Husková, Zdeňka Vaňourková, Zdenka Vernerová, Věra Certíková Chábová, Petra Skaroupková, Herbert J Kramer, Vladimír Tesař, Luděk Červenka
Our previous studies in rats with ablation nephrectomy have shown similar cardiorenal protective effects of renin-angiotensin system (RAS)-dependent treatment (combination of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker) and RAS-independent treatment (combination of α- and β-adrenoreceptor antagonist and diuretics). Moreover, selective blockade of endothelin (ET) receptor type A (ET(A)) improved survival rate and attenuated hypertension and organ damage in Ren-2 transgenic rats...
2012: Kidney & Blood Pressure Research
Anjay Rastogi, Mohamad Rashid, Richard F Wright
Interruption of the renin-angiotensin-aldosterone system (RAAS) cascade with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or more recently direct renin inhibitors (DRIs) is a safe and effective antihypertensive strategy that is in routine clinical use. The clinical utility of these agents in cardiorenal end-organ protection is increasingly being recognized. Although both ACE inhibitors and ARBs demonstrate substantial benefit in patients with cardiovascular and/or renal disease, considerable evidence indicates that they only partially suppress the RAAS pathway due to feedback upregulation of plasma renin activity...
November 2011: Journal of Clinical Hypertension
Mirna Krajina-Andricević, Lada Zibar, Karin Juras, Sanda Goll-Barić, Jerko Barbić
Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1...
June 2011: Collegium Antropologicum
M Azizi, M Frank, O Steichen, A Blanchard
In the current context of renin-angiotensin-aldosterone system (RAAS) blockade, angiotensin (Ang) converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), or their combination, have proved to be effective in providing cardiovascular and renal protection. However, renin inhibition has long been recognized as the preferred site for blockade of the RAAS because renin represents the first, highly-regulated and rate-limiting step of the system. Up to now, the first orally active renin inhibitors initially tested in humans did not meet the necessary all the criteria (specificity, potency, and pharmacokinetic profile) to become clinically useful drugs...
May 2011: Annales Pharmaceutiques Françaises
Wei Liu, Wei Wang, Shu-Wei Song, Xiao-Fei Gu, Xiu-Juan Ma, Feng-Yun Su, Hao Zhang, Ai-Jun Liu, Ding-Feng Su
AIM: This study was designed to investigate the effects of telmisartan and amlodipine on reduction of blood pressure (BP), myocardial hypertrophy, and renal injury in hypertensive rats. METHOD: In acute experiments, the BP was measured in conscious freely moving rats. Spontaneously hypertensive rats were treated with intragastric administration of amlodipine (1, 2, 4 mg/kg), telmisartan (4, 8, 12, 16, 20 mg/kg), and their different combinations (4 + 4, 2 + 4, 4 + 8, 4 + 12, 1 + 4, 2 + 8, 4 + 16, 2 + 12, 1 + 8, 2 + 16, 2 + 20, 1 + 12, 1 + 16, 1 + 20 mg/kg)...
March 2011: Journal of Cardiovascular Pharmacology
Xian Wu Cheng, Masafumi Kuzuya, Takeshi Sasaki, Aiko Inoue, Lina Hu, Haizhen Song, Zhe Huang, Ping Li, Kyosuke Takeshita, Akihiro Hirashiki, Kohji Sato, Guo-Ping Shi, Kenji Okumura, Toyoaki Murohara
OBJECTIVE: The mineralocorticoid receptor has been implicated in the pathogenesis of chronic cardiorenal disease. Statins improve renal remodeling and dysfunction in patients with proteinuric kidney diseases. We aimed to clarify the beneficial effects and mechanisms of action of statins in renal insufficiency. METHODS AND RESULTS: Dahl salt-sensitive rats fed a high-salt diet were treated from 12 to 20 weeks of age with vehicle, the reduced nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase inhibitor apocynin, the synthetic cathepsin inhibitor E64d, or a low or high dosage of pitavastatin (1 or 3 mg/kg daily)...
March 2011: Journal of Hypertension
Benjamin J Epstein
Combination therapy is necessary for most patients with hypertension, and agents that inhibit the renin-angiotensin-aldosterone system (RAAS) are mainstays in hypertension management, especially for patients at high cardiovascular and renal risk. Single blockade of the RAAS with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) confers some cardiorenal protection; however, these agents do not extinguish the RAAS as evidenced by a reactive increase in plasma renin activity (PRA), a cardiovascular risk marker, and incomplete cardiorenal protection...
2010: Vascular Health and Risk Management
M A Weber
Diabetes and hypertension frequently coexist, with effects potentially more detrimental than those of either condition alone. The combination increases the risk of both cardiovascular and renal morbidity and mortality. Antihypertensive drug therapy is of benefit to both nondiabetic and diabetic patients, but the greatest reduction in risk is seen in those with diabetes. Studies have shown the cardiorenal protective effects of therapy with angiotensin-converting enzyme inhibitors either alone or combined with calcium channel blockers...
October 2000: Postgraduate Medicine
Christos Chatzikyrkou, Jan Menne, Hermann Haller
Inhibition of the renin-angiotensin system (RAS) either with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) has been shown to be beneficial for cardiorenal protection. The combination of both is an exciting prospect and pathophysiologically plausible. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study provides evidence that dual blockade does not further reduce cardiovascular events or worsen renal outcomes. However, in patients with existing diabetic nephropathy, a trend towards a better outcome was observed...
June 2009: Journal of Hypertension. Supplement: Official Journal of the International Society of Hypertension
Rigas Kalaitzidis, George Bakris
Drugs that inhibit the renin-angiotensin-aldosterone system (RAAS) are the cornerstone of therapy for cardiovascular and renal disease because they protect against worsening outcomes in the respective target organs. Recent results from the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) have confirmed that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) confer similar cardioprotection and renoprotection, showing little to no benefit from the combination in cardiovascular disease...
March 2009: Postgraduate Medicine
Mustafa Arici, Yunus Erdem
The renin-angiotensin system (RAS) has an important role in hypertension and the continuum of cardiovascular and kidney disease. The inhibition of this system, either with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), has been shown to be beneficial for cardiorenal protection. Dual blockade with an ACE inhibitor and ARB may have additional benefits due to the more complete inhibition of the system. Most published trials, including recent large studies and meta-analyses, have reported either limited or no additional benefit...
February 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
D Legrand, J-M Krzesinski, A J Scheen
The blockade of the renin-angiotensin-aldosterone system (RAAS) is helpful in the management of arterial hypertension, congestive heart failure, post-myocardial infarction and diabetic nephropathy. Such blockade can be obtained with an angiotensin converting enzyme inhibitor, a specific antagonist of angiotensin II AT1 receptors, an aldosterone receptor antagonist and/or a direct inhibitor of renin such as aliskiren. Various studies have demonstrated that a dual or even triple RAAS inhibition may offer a better cardiorenal protection, in refractory congestive heart failure and in nephropathy with proteinuria...
August 27, 2008: Revue Médicale Suisse
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