Präventiv-Strategien: ACE-Hemmer, Sartane oder direkte Reninhemmung

Abstract

Experimental and clinical data suggest a major role of the renin angiotensin system (RAS) in the pathogenesis of cardiovascular and renal disease. This concept is further strengthened by clinical studies demonstrating the effectivity of ACE-inhibitors and AT₁-antagonists in different clinical situations. At present, three different groups of drugs are available for blocking the RAS: ACE-inhibitors, AT₁-antagonists and the direct renin inhibitor aliskiren. While at present only limited information is available for aliskiren, both ACE-inhibitors and AT₁-antagonists have been studied in numerous trials including four large „head to head” comparisons. These studies are unable to demonstrate differences in clinical outcomes with these two groups of drugs with the exception of a better tolerability and safety profile of the AT₁-antagonists. While combination of ACE-inhibitors and AT₁-antagonists is still a recommended treatment option for heart failure on the basis of the available evidence, data from the VALIANT and the ONTARGET studies argue against that combination in other clinical settings.

Literatur

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