The renin-angiotensin system

The renin-angiotensin system is among the most important endogenous regulators of blood pressure. Angiotensin peptides are generated locally in the kidneys as well as in blood vessels. The major effects of the system are caused by the binding of angiotensin II to its type 1 cell surface receptor. This receptor mediates increased blood pressure and glomerular filtration pressure, as well as stimulation of inflammation and fibrosis. Three classes of inhibitors of the renin-angiotensin system are available: renin inhibitors, ACE inhibitors and angiotensin receptor blockers. ACE inhibitors have been studied most extensively. Blockers of the renin-angiotensin system exert a unique combination of beneficial effects in patients with hypertension and chronic kidney disease. These drugs lower blood pressure, ameliorate the systemic sequelae of hypertension ( e. g. left ventricular hypertrophy), prevent cardiovascular events, decrease proteinuria and retard the progression of chronic kidney failure.