Vol 24, No 2 (2020)
REVIEW
Published online: 2020-06-01
Controversy over renin–angiotensin–aldosterone system (RAAS) inhibitors treatment in nephrology and cardiovascular diseases
Arterial Hypertension 2020;24(2):45-55.
Abstract
Drugs that act by inhibiting the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme
inhibitors (ACE-Is) and angiotensin II receptor type 1 (AT1) blockers (ARBs), have been recognized as a basic
canon of nephroprotection for years. They are commonly used in monotherapy for glomerulonephritis with proteinuria.
At present, they are rarely used in combination therapy in a form of dual blockade of RAAS due to concern
about possible side effects. On the other hand, both ACE-Is and ARBs are also wrongly referred to as nephrotoxic
drugs. The significance of therapy with these drugs is seen in evoking acute kidney injury (AKI) or acceleration of
CKD. The aim of this article was to clarify the opinion on the relationship between ACE-Is or ARBs treatment and
AKI occurrence, and to attempt to reassess the role of dual RAAS blockade in the treatment of kidney diseases. The
principles of heart failure (HF) therapy with ACE-Is or ARBs and current data on the importance of RAAS dual
blockade in hypertension are also discussed.
Keywords: acute kidney injurychronic kidney diseaserenin–angiotensin–aldosterone systemdual RAAS blockadehalting the progression of kidney disease
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