RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM AND HEART-FAILURE - PATHOPHYSIOLOGIC AND THERAPEUTIC ASPECTS

Renin, angiotensin II and aldosterone levels are elevated in congestiv e heart failure, especially when diuretics are introduced. This activa tion is clearly deleterious by elevating myocardial workload and is re lated to prognosis of heart failure. The link between hormonal activat ion and prognosis is causal, as hormonal inhibition by converting enzy me inhibitors improves heart failure prognosis. Angiotensin II and ald osterone appears to be toxic for the myocardium. The results of the tr ial conducted with angiotensin II antagonist losartan confirm data der ived from converting-enzyme-inhibitors trials. The exact role of aldos terone is currently being evaluated in the RALES programme.