[Renin-angiotensin-aldosterone system blockers in the treatment of patients with cardiovascular diseases combined with bronchial obstruction diseases: a review].

Abstract

The renin-angiotensin-aldosterone system (RAAS) is the main target of pharmacological agents used to achieve blood pressure reduction as well as cardio- and nephroprotection in patients with cardiovascular diseases (CVD). However, the use of drugs from this group, primarily angiotensin-converting enzyme inhibitors (ACE inhibitors), may lead to the development of adverse events (AEs) in patients with obstructive lung diseases (OLD). ACE inhibitors and angiotensin II receptor blockers (ARBs) have comparable efficacy in the treatment of CVD. In the event of AEs, patients receiving ACE inhibitors for arterial hypertension may be switched to ARBs. However, for the treatment of chronic heart failure with reduced ejection fraction, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction, ACE inhibitors are recommended as first-line therapy; the benefits of ARBs in these conditions have not been proven. Mineralocorticoid receptor antagonists (MRAs) are also frequently prescribed to patients with CVD as part of combination therapy. In addition to their proven efficacy in the treatment of CVD, spironolactone and eplerenone have demonstrated antifibrotic and anti-inflammatory effects in a number of studies, including effects in lung tissue, as well as the ability to influence the progressive course of fibrotic diseases. This class of drugs is being intensively studied. In the United States, Europe, and Japan, new agents from the subclass of nonsteroidal MRAs have been approved. Currently, investigation of the potential of MRAs is highly promising for patients with coexisting CVD and OLD, given the potential of these drugs to affect inflammation and fibrosis in lung tissue. Thus, this review is devoted to the analysis of the efficacy and safety of RAAS-targeting drugs in patients with CVD and OLD, the causes of adverse events, and proposes management strategies for their occurrence and possible correction.