scholarly journals Coronary Vasculature and Myocardial Structure in HIV: Physiologic Insights from the Renin-Angiotensin-Aldosterone System

2021 ◽  
Author(s):  
Suman Srinivasa ◽  
Teressa S Thomas ◽  
Meghan N Feldpausch ◽  
Gail K Adler ◽  
Steven K Grinspoon
Keyword(s):  
Cardiovascular Disease ◽  
Myocardial Injury ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade ◽  
Antiretroviral Therapies ◽  
Potential Mediator ◽  
Virologic Control ◽  
Hormonal System ◽  
Myocardial Structure

Abstract The landscape of HIV medicine dramatically changed with the advent of contemporary antiretroviral therapies (ART) which has allowed persons with HIV (PWH) to achieve good virologic control, essentially eliminating HIV-related complications and increasing life expectancy. As PWH are living longer, non-communicable diseases, such as cardiovascular disease (CVD), have become a leading cause of morbidity and mortality in PWH with rates that are 50-100% higher than in well-matched persons without HIV. In this review, we focus on disease of the coronary microvasculature and myocardium in HIV. We highlight a key hormonal system important to cardiovascular endocrinology, the renin-angiotensin-aldosterone system (RAAS), as a potential mediator of inflammatory driven-vascular and myocardial injury and consider RAAS blockade as a physiologically-targeted strategy to reduce CVD in HIV.

scholarly journals The Role of the Renin-Angiotensin-Aldosterone System in Cardiovascular Disease: Pathogenetic Insights and Clinical Implications

2021 ◽  
Author(s):  
Violeta Capric ◽  
Harshith Priyan Chandrakumar ◽  
Jessica Celenza-Salvatore ◽  
Amgad N. Makaryus
Keyword(s):  
Cardiovascular Disease ◽  
Renal Disease ◽  
Clinical Implications ◽  
Pathological Changes ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade ◽  
Adverse Remodeling ◽  
Artery Disease

Increased attention has been placed on the activation of the renin-angiotensin-aldosterone system (RAAS) and pathogenetic mechanisms in cardiovascular disease. Multiple studies have presented data to suggest that cardiac and arterial stiffness leading to adverse remodeling of both the heart and vasculature leads to the various pathological changes seen in coronary artery disease, heart failure (with preserved and reduced ejection fractions), hypertension and renal disease. Over-activation of the RAAS is felt to contribute to these structural and endocrinological changes through its control of the Na+/K+ balance, fluid volume, and hemodynamic stability. Subsequently, along these lines, multiple large investigations have shown that RAAS blockade contributes to prevention of both cardiovascular and renal disease. We aim to highlight the known role of the activated RAAS and provide an updated description of the mechanisms by which activation of RAAS promotes and leads to the pathogenesis of cardiovascular disease.

scholarly journals Clinical Implication of the Renin-angiotensin-aldosterone Blockers in Chronic Kidney Disease Undergoing Hemodialysis

2014 ◽  
Vol 8 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Yoshiyuki Morishita ◽  
Eiji Kusano ◽  
Daisuke Nagata
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Implication ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Beneficial Effects

The renin-angiotensin-aldosterone system (RAAS) blockers have been widely used in chronic kidney disease patients undergoing hemodialysis; however, whether RAAS blockers have beneficial effects for cardiovascular disease in those patients has not been fully defined. This review focuses on the effects of RAAS blockers in chronic kidney disease undergoing hemodialysis for cardiovascular disease.

scholarly journals Role of the Renin-Angiotensin-Aldosterone System in Dystrophin-Deficient Cardiomyopathy

2020 ◽  
Author(s):  
Moises Rodriguez-Gonzalez ◽  
Manuel Lubian-Gutierrez ◽  
Helena Maria Cascales-Poyatos ◽  
Alvaro Antonio Perez-Reviriego ◽  
Ana Castellano-Martinez
Keyword(s):  
Therapeutic Strategy ◽  
Clinical Evidence ◽  
Enzyme Inhibitors ◽  
English Literature ◽  
Current Evidence ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade ◽  
Comprehensive Search

Dystrophin-deficient cardiomyopathy (DDC) is currently the leading cause of death in patients with dystrophinopathies. Targeting myocardial fibrosis (MF) has become a major therapeutic goal in order to prevent the occurrence of DDC. We aimed to review and summarize the current evidence about the role of the renin-angiotensin-aldosterone system (RAAS) in the development and perpetuation of MF in DCC. We conducted a comprehensive search of peer-reviewed English literature on PubMed about this subject. We found increasing preclinical evidence from studies in animal models during the last 20 years pointing out a central role of RAAS in the development of MF in DDC. Local tissue RAAS acts directly mainly through its main fibrotic component angiotensin II (ANG2) and its transducer receptor (AT1R) and downstream TGF-b pathway. Also, it modulates the actions of most of the remaining pro-fibrotic factors involved in DDC. Despite limited clinical evidence, RAAS blockade constitutes the most studied, available and promising therapeutic strategy against MF and DDC. Conclusion: Based on the evidence reviewed, it would be recommendable to start RAAS blockade therapy through angiotensin converter enzyme inhibitors (ACEI) or AT1R blockers (ARBs) alone or in combination with mineralocorticoid receptor antagonists (MRa) at the youngest age after the diagnosis of dystrophinopathies, in order to delay the occurrence or slow the progression of MF, even before the detection of any cardiovascular alteration.

Recent Advances in the Knowledge of Naturally-derived Bioactive Compounds as Modulating Agents of the Renin-angiotensin-aldosterone System: Therapeutic Benefits in Cardiovascular Diseases

2019 ◽  
Vol 25 (6) ◽  
pp. 670-684 ◽  
Author(s):  
Priscila de Souza ◽  
Luisa M. da Silva ◽  
Sérgio F. de Andrade ◽  
Arquimedes Gasparotto Junior
Keyword(s):  
Cardiovascular Diseases ◽  
Bioactive Compounds ◽  
Current Therapy ◽  
Renal Diseases ◽  
Attractive Alternative ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade ◽  
Therapeutic Benefits ◽  
Cardiovascular Morbidity And Mortality

Background: One of the biggest challenges to public health worldwide is to reduce the number of events and deaths related to the cardiovascular diseases. Numerous approaches have been applied to reach this goal, and drug treatment intervention has been indispensable along with an effective strategy for reducing both cardiovascular morbidity and mortality. Renin-angiotensin-aldosterone system (RAAS) blockade is currently one of the most important targets of cardiovascular drug therapy. Many studies have proven the valuable properties of naturally-derived bioactive compounds to treat cardiovascular diseases. Methods: The goal of this review, therefore, is to discuss the recent developments related to medicinal properties about natural compounds as modulating agents of the RAAS, which have made them an attractive alternative to be available to supplement the current therapy options. Results: Data has shown that bioactive compounds isolated from several natural products act either by inhibiting the angiotensin-converting enzyme or directly by modulating the AT1 receptors of angiotensin II, which consequently changes the entire classical axis of this system. Conclusion: While there are a few evidence about the positive actions of different classes of secondary metabolites for the treatment of cardiovascular and renal diseases, data is scarce about the clinical assays established to demonstrate their value in humans.

Effect of renin-angiotensin-aldosterone system (RAAS) blockade on visfatin levels in diabetic nephropathy

Nephrology ◽  
2010 ◽  
Vol 15 (2) ◽  
pp. 225-229 ◽  
Author(s):  
TAYFUN EYILETEN ◽  
ALPER SONMEZ ◽  
MUTLU SAGLAM ◽  
ERDINC CAKIR ◽  
KAYSER CAGLAR ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade

scholarly journals Cushing's disease and hypertension: in vivo and in vitro study of the role of the renin-angiotensin-aldosterone system and effects of medical therapy

2014 ◽  
Vol 170 (2) ◽  
pp. 181-191 ◽  
Author(s):  
R van der Pas ◽  
J H M van Esch ◽  
C de Bruin ◽  
A H J Danser ◽  
A M Pereira ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cushing’S Disease ◽  
In Vitro Study ◽  
Cushing's Disease ◽  
Ang Ii ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Raas Blockade

Objective/methodsCushing's disease (CD) is often accompanied by hypertension. CD can be treated surgically and, given the expression of somatostatin subtype 5 and dopamine 2 receptors by corticotroph pituitary adenomas, pharmacologically. Indeed, we recently observed that stepwise medical combination therapy with the somatostatin-analog pasireotide, the dopamine-agonist cabergoline, and ketoconazole (which directly suppresses steroidogenesis) biochemically controlled CD patients and lowered their blood pressure after 80 days. Glucocorticoids (GC) modulate the renin–angiotensin–aldosterone system (RAAS) among others by increasing hepatic angiotensinogen expression and stimulating mineralocorticoid receptors (MR). This study therefore evaluated plasma RAAS components in CD patients before and after drug therapy. In addition, we studied whether cabergoline/pasireotide have direct relaxant effects in angiotensin II (Ang II)-constricted iliac arteries of spontaneously hypertensive rats, with and without concomitant GR/MR stimulation with dexamethasone or hydrocortisone.ResultsBaseline concentrations of angiotensinogen were elevated, while renin and aldosterone were low and suppressed, respectively, even in patients treated with RAAS-blockers. This pattern did not change after 80 days of treatment, despite blood pressure normalization, nor after 4 years of remission. In the presence of dexamethasone, pasireotide inhibited Ang II-mediated vasoconstriction.ConclusionsThe low plasma renin concentrations, even under RAAS blockade, in CD may be the consequence of increased GC-mediated MR stimulation and/or the elevated angiotensinogen levels in such patients. The lack of change in RAAS-parameters despite blood pressure and cortisol normalization suggests persisting consequences of long-term exposure to cortisol excess. Finally, pasireotide may have a direct vasodilating effect contributing to blood pressure lowering.

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