Renin-angiotensin system inhibition: how much is too much of a good thing?

Abstract

Inhibitors of the renin-angiotensin system (RAS) are valuable therapeutic agents for a wide range of clinical conditions. Increasingly, consideration is being given to the combination of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor (AR) antagonists to obtain more complete inhibition of the RAS than can be achieved by either agent alone. Beta-blockers also inhibit the RAS by inhibiting renin secretion. Whereas the combination of an ACE inhibitor and AR antagonist represents dual RAS inhibition, the combination of both of these agents with beta-blocker therapy represents triple RAS inhibition. Animal studies indicate that complete blockade of the RAS produces adve..