The role of the renin-angiotensin-aldosterone system in the management of heart failure

Numerous clinical trials have highlighted the role of the renin-angiotensin -aldosterone (RAA) system in the development and progression of heart failu re. Over 30 randomized, controlled trials have evaluated the effects of ang iotensin-converting enzyme (ACE) inhibitors on morbidity and mortality in o ver 7000 patients with heart failure. Cumulative evidence from these trials shows that these agents significantly reduce mortality and hospitalization s, slow disease progression, and improve exercise tolerance and New York He art Association class. The Heart Failure Society of America guidelines reco mmend ACE inhibitors as standard therapy for patients with left ventricular systolic dysfunction. The angiotensin receptor blockers and spironolactone offer alternative and perhaps complimentary mechanisms by which the RAA sy stem may be therapeutically manipulated. The role of these therapies in tre ating heart failure is discussed.