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"nephropathy"

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Despite standard therapy, patients with stable ischemic heart disease and preserved left ventricular systolic function continue to be at risk for future cardiovascular events. The Renin-Angiotensin-Aldosterone System (RAAS) is critical for regulating blood pressure, electrolyte balance, and fluid volume homeostasis and plays a pivotal role in the pathogenesis of hypertension, congestive heart failure, and diabetic nephropathy. Pharmacological agonists of this system include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs). These drugs block adverse effects of the RAAS by blocking the activity of angiotensin II. Through the stimulation of angiotensin II type-1 receptors, angiotensin II may have several potentially harmful activities including induction of aldosterone production, which can cause sodium retention and increased fluid retention that, in turn, leads to an increase in blood pressure, increased aldosterone production, which can possibly lead to promotion of pathogenic remodeling (i.e., atherosclerosis and fibrosis), constriction of blood vessels, which can lead to increased blood pressure, and potential reduction in the availability of nitric oxide through the production of free radicals and the induction of endothelial dysfunction that may impact endothelial wall integrity. ACEIs act on the RAAS by blocking the conversion of angiotensin I into angiotensin II and inhibiting the breakdown of bradykinin, which is a potent vasodilator. ARBs block the angiotensin II type-1 receptor and reduce the pharmacologic effects of angiotensin II, regardless of whether angiotensin II is created by the angiotensin-converting enzyme or by pathways that do not include this enzyme. ACEIs and ARBs may potentially provide several pharmacological effects over and above that of blood pressure reduction alone, which may impact cardiovascular events.
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Pharmacologic Effects of Antagonists on the Renin-Angiotensin-Aldosterone System

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: angiotensin II-receptor blocker | angiotensin-converting enzyme inhibitor | renin-angiotensin-aldosterone system | pharmacology
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Background: Complications

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: type 2 diabetes | complications | cardiovascular disease | kidney disease | retinopathy | neuropathy | nephropathy
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Rationale for Update

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: comparative effectiveness review | systematic review | type 2 diabetes | noninsulin injectables | DPP-4 inhibitors | medications for type 2 diabetes
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Macrovascular and Microvascular Long-Term Clinical Outcomes of Diabetes

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: macrovascular | microvascular | long-term outcomes | mortality | cardiovascular mortality | morbidity
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Long-Term Clinical Outcomes: Overview

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: long-term clinical outcomes | mortality | morbidity | cardiovascular disease | nephropathy
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Comparative Effectiveness and Safety in Subpopulations

Presentation: Comparing Medications for Adults With Type 2 Diabetes
Keywords: safety | subpopulations | effectiveness | bone fractures in women | subgroup analysis
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Background: Disease Burden of Diabetes Mellitus

Presentation: Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness
Keywords: diabetes | complications | microvascular | macrovascular | pregnancy | outcomes
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II-receptor blockers (ARBs) are proven therapies that reduce morbidity and mortality in patients with left ventricular systolic dysfunction (LVSD) with chronic heart failure, and have also shown to reduce the progression of nephropathy in patients with diabetes mellitus and proteinuria. It is less clear how ACEIs contribute to the reduction of cardiovascular events in patients with stable IHD who also have preserved left ventricular systolic function (LVSF), as determined by a left ventricular ejection fraction (LVEF) >40%. These patients have relatively intact LVSF, yet may present with chest pain (angina pectoris) brought on by emotional or physical stress. These symptoms are usually due to one or more clogged or diseased arteries that result in reduced blood flow and oxygen supply to the heart. Therapies shown to reduce the risk for cardiovascular events in IHD patients include aspirin, statins, beta-blockers, and dual anti-platelet therapy. Other agents used for symptomatic relief include nitrates and calcium channel blockers (CCB). A revascularization procedure to circumvent or treat a blocked vessel is another therapeutic option for patients unresponsive or intolerant to these medications. A patient will need prolonged treatment with these medications to reduce anginal symptoms, increase quality of life, and reduce the risk of fatal and nonfatal cardiovascular events. A comparative effectiveness review was conducted to synthesize the evidence surrounding the additional cardiovascular benefits from adding ACEIs and/or ARB therapy to the long-term care regimens of stable IHD patients with intact LVSF, and if those benefits outweigh the potential side effects of these drugs. This case study will seek to evaluate ACEIs and/or ARBs in stable ischemic heart disease patients with preserved LVSF.
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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Presentation: Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: case study | stable ischemic heart disease | left ventricular systolic function | angiotensin-converting enzyme inhibitors | angiotensin II-receptor blockers
Pharmacologic Effects of Antagonists on the Renin-Angiotensin-Aldosterone System Despite standard therapy, patients with stable ischemic heart disease and preserved left ventricular systolic function continue to be at risk for future cardiovascular events. This slide represents several pathways involved in the Renin-Angiotensin-Aldosterone System (RAAS), which is critical for regulating blood pressure, electrolyte balance, and fluid volume homeostasis and plays a pivotal role in the pathogenesis of hypertension, congestive heart failure, and diabetic nephropathy. Pharmacological antagonists of this system include angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II-receptor blockers (ARBs). These drugs block adverse effects of the RAAS by blocking the activity of angiotensin II through different mechanisms as shown in the slide: ACEIs act on the RAAS by blocking the conversion of angiotensin I into angiotensin II and inhibiting the breakdown of bradykinin, which is a potent vasodilator. ARBs block the angiotensin II type-1 receptor and reduce the pharmacologic effects of angiotensin II, regardless of whether angiotensin II is created by the angiotensin-converting enzyme or by pathways independent of this enzyme.
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Pharmacologic Effects of Antagonists on the Renin-Angiotensin-Aldosterone System

Presentation: Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
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Clinical Questions Addressed by the Comparative Effectiveness Review (2 of 2)

Presentation: Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women
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Gaps in Knowledge and Future Research Needs (2 of 2)

Presentation: Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women
Keywords: knowledge gaps | future research needs | coronary artery disease | CAD | women | diagnosis | noninvasive technologies
 
 
 
 
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