Renin Angiotensin Aldosterone – Drugs in Hypertension

by Pravin Shukle, MD

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    Okay. Let's move on to RAAS agents, the renin angiotensin aldosterone pathway. So, let's take a look at how the pathway works. We start off with the prohormone called angiotensinogen. In the kidney, renin converts angiotensinogen into angiotensin I. And it is then converted by the angiotensin converting enzyme into angiotensin II. Now, ACE inhibitors will block this particular enzyme. And when that happens, you will have less angiotensin II. Now, the other thing that happens with this agent is that when you block the conversion of angiotensin I into angiotensin II, you're also similarly blocking the breakdown of bradykinins. Now, bradykinins are things that you don't really want in the body because they can cause cough and these other symptoms that I've got listed here. So, ACE inhibitors cause cough because they also inhibit the breakdown of bradykinin. Let's get back to angiotensin II. You notice on the end of our slide there, on the far end of our slide, we also have non ACE pathways. So, there is still some conversion of angiotensin I into angiotensin II even if you blocked the ACE enzyme with an ACE inhibitor. This brings us down to the angiotensin receptor. So, we have angiotensin receptor blockers. And what we want to do is we want to block the production of aldosterone. Now remember that aldosterone has lots of effects on the body. It decreases water and sodium excretion, and it will actually cause a higher blood pressure. So, by giving a drug that blocks the conversion of angiotensin II into the various aldosterone molecules, it's going to be very important so that's why we block it with the ARB. Now remember, I already mentioned that spironolactone is an aldosterone blocker, it blocks it right at the receptor site. So, it's a very...

    About the Lecture

    The lecture Renin Angiotensin Aldosterone – Drugs in Hypertension by Pravin Shukle, MD is from the course Cardiovascular Pharmacology. It contains the following chapters:

    • The Renin Angiotensin Aldosterone Pathway
    • The Renin Angiotensin Aldosterone System Drugs

    Included Quiz Questions

    1. Lorenapril
    2. Lorenidartan
    3. Lorestatin
    4. Lorenartan
    5. Lorenaprin
    1. Spirinolactone
    2. Aliskiren
    3. Captopril
    4. Valsartan
    5. Losartan
    1. Pancreatitis
    2. Cough
    3. Headaches
    4. Feminization
    5. Hyperkalemia
    1. Aliskiren
    2. Losartan
    3. None of the RAAS drugs cause diarrhea.
    4. Spirinolactone
    5. Captopril
    1. Patients are more compliant with ARBs as they are better tolerated.
    2. The shelf-life of ACEIs is shorter than ARBs, so they lose potency more quickly over time.
    3. ACEIs have been shown to be more effective in practice than ARBs.
    4. Only ARBs can be combined with diuretics, leading to a synergistic effect.
    5. Patients are more compliant with ARBs because ACEIs are more expensive.

    Author of lecture Renin Angiotensin Aldosterone – Drugs in Hypertension

     Pravin Shukle, MD

    Pravin Shukle, MD

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    Great lecture
    By Jacob S. on 05. March 2017 for Renin Angiotensin Aldosterone – Drugs in Hypertension

    Dr. Shunkle provides a great explanation of the RAAS. The lecture follows nicely along with my book and studies.