The renin angiotensin system (RAS) plays a key role in the regulation of cardiovascular function, with angiotensin II being involved in hemodynamic and non-hemodynamic mechanism in the pathophysiology of cardiovascular disease. A number of studies demonstrated that pharamacological modulation of the RAS, either with angiotensin converting (ACE) inhibitor or an angiotensin II receptor blocker (ARB), provides cardiovascular and renal protection. Blockade of the RAS, either with ACE inhibitors or ARBs, decreases cardiovascular morbidity and mortality in high risk patients. ACE inhibitors as well as ARBs are drugs of choice in congestive heart failure, as well as in diabetic nephropathy. Especially, the combined RAS blockade with ACE inhibitors and ARBs was more effective than monotherapy in diabetic or non-diabetic nephropathy with proteinuria. However, this combined RAS blockade was not equally dominant in treatment of hypertension and was not recommended for widespread antihypertensive use.
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