Modulating the Renin Angiotensin System

There is compelling evidence that modulating the RAS attenuates renal disease progression through blood pressure-independent mechanisms (Figure 9). For example, the ACE inhibitor enalapril slows the progression of end-stage renal failure compared with b-adrenoceptor blockers although blood pressure control is similar in both treatment groups. These data suggest that the protective effect of enalapril on renal function was not mediated through blood pressure and it could be attributed to the blocking of AT-II-induced increase in ROS, growth factors, inflammatory cytokines, and interstitial fibrosis. Therefore, interfering with the RAS may reduce proteinuria and provide a renoprotective effect in hypertension and diabetes.

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