Renin-angiotensin-aldosterone system for blood pressure and electrolyte homeostasis and its involvement in hypertension, in congestive heart failure and in associated cardiovascular damage (myocardial infarction and stroke).

The renin-angiotensin-aldosterone hormonal servo-control system plays a major role in defending normotension and sodium and potassium balance. Derangements of the system involving either excess renin-angiotensin vasoconstriction or too much sodium-volume retention for the plasma-renin level can be implicated in sustaining the hypertension of most human hypertensive disorders. When plasma renin levels are inappropriately or inordinately increased, ischemic vascular injury to the heart, brain and kidneys becomes increasingly evident. In this setting, pharmacologic suppression or blockade of plasma renin activity protects from further cardiovascular damage in experimental models, in human hypertensive disorders and in human congestive heart failure. Still other studies suggest that excessive plasma prorenin levels may be involved in the vasodilator hyperperfusion vascular injury of diabetes mellitus. Recent findings provide considerable promise for pharmacologic strategies that suppress or block plasma renin activity in patients with hypertension or with congestive heart failure for achieving long-term protection from the major cardiovascular sequellae that shorten useful life. Future research to define better the factors that control renal renin gene expression and renal renin secretion could lead to even better treatment and prevention strategies.