[Activation of the renin-angiotensin-aldosterone system in heart failure].

Several studies have demonstrated that a prolonged over-activation of neurohormonal mechanisms contributes to drive structural and functional abnormalities of the cardiovascular system and leads to poor prognosis in patients with congestive heart failure (CHF). In particular, activation of the renin-angiotensin-aldosterone system (RAAS) leads to increased levels of angiotensin II and plasma aldosterone, and promote development of arterial vasoconstriction and remodeling, sodium retention, oxidative process, and cardiac fibrosis. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and beta-blockers may modulate this excessive over-activity and improve survival in those patients. However, high circulating and tissue levels of angiotensin II and aldosterone may persist and contribute to further progression of CHF. Many aspects of the pathophysiological role of the RAAS in CHF are still debated, and a more thorough comprehension of this fundamental system is needed. This article reviews the current knowledge on the biochemical and functional organization of the RAAS, its pathophysiological role in CHF, and the potential therapeutic implications

Fewer mega-trials and more clinically oriented studies in hypertension research? The case of blocking the renin-angiotensin-aldosterone system.

In recent years, medical practice has been influenced substantially by several factors, including the overwhelming development of evidence-based medicine, which is a consequence of the impressive, growing number of large clinical trials, the so-called "mega-trials." These clinical studies are designed mostly to investigate the effects of drugs or treatments on hard end points that cannot be tested by individual physicians in their daily clinical practice. The growing role of this epidemiologic approach to medicine, which is based mostly on the assessment of the average response or behavior of large populations rather than of individuals, is systematically replacing the former knowledge and reference points of the physician, as a substitute rather than as an aid. Taking into account the case of hypertension and particularly the renin-angiotensin system-blocking agents, this article reviews the issues and limitations of transferring evidence from mega-trials to clinical practice and suggests new strategies to make trials more effective and transferable to the case of individual patients

Hypertension and heart failure: role of neurohormonal mechanisms.

Hypertension represents the most common associated cause of heart failure, and it is frequently involved in the pathogenesis of left ventricular dysfunction and its progression towards congestive heart failure. A common pathophysiological link of hypertension to heart failure is represented by the abnormalities of the neurohormonal profile and its impact on cardiac function, systemic hemodynamics and salt/water balance. This article synthetically reviews this aspect together with a specific analysis of the significance of measurements of neurohormones for diagnosis and prognostic stratification in heart failure

Simultaneous Takotsubo syndrome in two sisters

[No abstract available