Inhibition of the renin-angiotensin-aldosterone system for cerebrorenal protection.

Blood pressure is a strong risk factor for ischemic and atherosclerotic events such as stroke. Blood pressure is often elevated in patients with chronic kidney disease. Consequently, chronic kidney disease patients are at high risk of developing cardiovascular and cerebrovascular damage. Blood pressure reduction by means of inhibiting the renin-angiotensin-aldosterone system (RAAS) reduces the risk of stroke. There is evidence available in the primary and secondary prevention of stroke that RAAS blockade exerts cerebrovascular protective effects independent of blood pressure lowering. This chapter discusses the role of RAAS blockade for the prevention and treatment of stroke in chronic kidney disease. The role of dual RAAS blockade will be reviewed and alternative strategies to enhance the effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers will be provided.