The renin-angiotensin system in essential hypertension: Associations with cardiovascular risk

The importance of the renin-angiotensin system (RAS) in blood pressure regu lation is well established. High RAS activity has also been implicated in c onnection with elevated cardiovascular risk in patients with essential hype rtension. Data from epidemiological studies have related high plasma renin levels in essential hypertensive patients to cardiovascular complications. However, whether renin itself is a risk factor of cardiovascular events or just acts as a marker for other risk factors still remains to be elucidated . Several possible mechanisms that could be responsible for the association between elevated RAS activity and cardiovascular risk are reviewed. The co ncept of high RAS activity being a cardiovascular risk factor is strongly s upported by results from large clinical studies showing the beneficial effe cts of angiotensin-converting enzyme inhibitors and angiotensin II: recepto r blockers in congestive heart failure and hypertension. Knowing more about the exact mechanisms of the association between high RAS activity and card iovascular complications would enable us to profile the treatment of high b lood pressure more specifically to improve outcome in individuals or groups of patients.