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Vol 24, No 2 (2020)
REVIEW
Published online: 2020-06-01
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Controversy over renin–angiotensin–aldosterone system (RAAS) inhibitors treatment in nephrology and cardiovascular diseases

Rafał Ł. Donderski1, Rafał Bednarski1, Jacek Manitius1
DOI: 10.5603/AH.a2020.0007
·
Arterial Hypertension 2020;24(2):45-55.
Affiliations
  1. Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland

open access

Vol 24, No 2 (2020)
REVIEW
Published online: 2020-06-01

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.

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.

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Keywords

acute kidney injury; chronic kidney disease; renin–angiotensin–aldosterone system; dual RAAS blockade; halting the progression of kidney disease

About this article
Title

Controversy over renin–angiotensin–aldosterone system (RAAS) inhibitors treatment in nephrology and cardiovascular diseases

Journal

Arterial Hypertension

Issue

Vol 24, No 2 (2020)

Pages

45-55

Published online

2020-06-01

Page views

1319

Article views/downloads

1058

DOI

10.5603/AH.a2020.0007

Bibliographic record

Arterial Hypertension 2020;24(2):45-55.

Keywords

acute kidney injury
chronic kidney disease
renin–angiotensin–aldosterone system
dual RAAS blockade
halting the progression of kidney disease

Authors

Rafał Ł. Donderski
Rafał Bednarski
Jacek Manitius

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