Dual RAAS Inhibition and Cardiorenal Disease: Is Enough Really Enough?

Since the frst appearance of captopril on the market in 1981, the management of cardiovascular and renal diseases relies greatly on the drugs inhibiting the renin angiotensin system (RAAS) [1] that have proven to be efective in the treatment of hypertension, heart failure, acute myocardial infarction and renal disease [1]. Ace-inhibitors (ACEI), angiotensin II receptor inhibitors (ARBs), Direct Renin inhibitors (DRI) and Aldosterone receptors blockers are commonly used in patients with or at risk or cardio-renal disease where they prevent cardiovascular complications and the decline of renal function [2]. All classes of drugs have a comparable antihypertensive efect with no clinically meaningful difference in blood pressure control in comparison with nonRAAS mediated classes of blood pressure lowering drugs and regardless of the methods employed to measure blood pressure [3]. ACEI and ARBs are the most investigated drugs and a large number of studies have been conducted to demonstrate their efcacy in a large population of hypertensive and non-hypertensive patients. The information about DRI is limited to two major trials mainly focused in patients with renal disease while the aldosterone receptors inhibitors have achieved some evidence in the management of resistant hypertension