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

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.