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More evidence on blocking the renin–angiotensin–aldosterone system in cardiovascular disease and the long-term treatment of hypertension: data from recent clinical trials (CHARM, EUROPA, ValHEFT, HOPE-TOO and SYST-EUR2)

Journal of Human Hypertension volume 17, pages 747–750 (2003)Cite this article

In February 2001, a Commentary in the Journal of Human Hypertension stated ‘… the renin–angiotensin–aldosterone system (RAAS) appears to be at the root of most of evil (in this instance, cardiovascular disease)’.1 Indeed, the RAAS is activated in conditions as diverse as hypertension, diabetes and heart failure.2 In the latter, for example, blockade of the RAAS with ACE inhibitors, and more recently, the ‘aldosterone’ component of the RAAS by the aldosterone antagonist, spironolactone or eplerenone,3 are established for the treatment of heart failure. The other class of drugs which blocks the RAAS are the angiotensin receptor blockers (ARBs), but in contrast to excellent data in hypertension, such as the LIFE trial,4 the data on ARBs in heart failure5 had failed to convince the most cynical of clinical pharmacologists.

Perhaps the worm has turned. The recent European Society of Cardiology meeting in Vienna, from 30th August to 3rd September 2003 provided us with important data on blockade of the RAAS in cardiovascular disease. Firstly, we had results of the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) programme presented, which clearly demonstrates a role for ARBs in congestive heart failure (CHF). Furthermore, we were presented data from the EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) study, which was the largest and longest trial of stable, relatively low-risk coronary artery disease patients. Furthermore, extended follow-up of the patients in the Heart Outcomes Prevention (HOPE) trial2 (by an additional 2.6 years) and the SYST-EUR trial6,7 (by an additional 4 years) were presented.

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  1. University Department of Medicine, City Hospital, Birmingham, England, UK

    G Y H Lip & D G Beevers

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Correspondence to G Y H Lip.

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Lip, G., Beevers, D. More evidence on blocking the renin–angiotensin–aldosterone system in cardiovascular disease and the long-term treatment of hypertension: data from recent clinical trials (CHARM, EUROPA, ValHEFT, HOPE-TOO and SYST-EUR2). J Hum Hypertens 17, 747–750 (2003). https://doi.org/10.1038/sj.jhh.1001650

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