Activation of the renin angiotensin aldosterone system ( RAAS ) has been shown to play an important role in cardiac and vascular injury and conversely inhibition and or blockade of this system reduces cardiovascular mortality and morbidity across a wide spectrum of cardiovascular diseases . There remains however controversy as to how best to negate the adverse effects of RAAS activation . The results of the ONTARGET ( 1 ) and TRANSEND ( 2 ) studies in patients with high risk vascular disease as well as a number of recent meta analyses of randomized trials comparing the efficacy and safety of angiotensin converting enzyme inhibitors ( ACE-Is ) to angiotensin receptor blocking agents ( ARBs ) and their combination in patients with heart failure ( HF ), hypertension , and chronic kidney disease focused attention on the RAAS and have provided some further insight into the most effective strategy to prevent the adverse effects of RAAS activation .These insights may however need to be modified as the results of new strategies to block/inhibit the RAAS become available . Furthermore , the question as to how best to to inhibit/block the RAAS may be disease specific . It should also be emphasized that despite over two decades of intensive preclinical and clinical investigation our understanding of the RAAS , the consequences of its activation, and the most effective strategy to prevent its activation remain incomplete .
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