Does the Naked Emperor Parable Apply to Current Perceptions of the Contribution of Renin Angiotensin System Inhibition in Hypertension?

AbstractPurpose of ReviewTo address contemporary hypertension challenges, a critical reexamination of therapeutic accomplishments using angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, and  a greater appreciation of evidence-based shortcomings from randomized clinical trials are fundamental in accelerating future progress.Recent FindingsMedications targeting angiotensin II mechanism of action are essential for managing primary hypertension, type 2 diabetes, heart failure, and chronic kidney disease. While the ability of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers to control blood pressure is undisputed, practitioners, hypertension specialists, and researchers hold low awareness of these drugs ’ limitations in preventing or reducing the risk of cardiovascular events. Biases in interpreting gained knowledge from data obtained in randomized clinical trials include a pervasive emphasis on usingrelative risk reduction overabsolute risk reduction. Furthermore, recommendations for clinical practice in international hypertension guidelines fail to address the significance of aresidual risk several orders of magnitude greater than the benefits. We analyze the limitations of the clinical trials that have led to current recommended treatment guidelines. We define and quantify the magnitude of theresidual risk in published hypertension trials and explore how activation of alternate compensatory bioprocessing components wi...
Source: Current Hypertension Reports - Category: Primary Care Source Type: research