The Role of the Renin-Angiotensin System in the Pathophysiology, Prevention, and Treatment of Renal Impairment in Patients With the Cardiometabolic Syndrome or Its Components
Article first published online: 21 JAN 2009
© 2009 Wiley Periodicals, Inc.
Journal of the CardioMetabolic Syndrome
Volume 4, Issue 1, pages 57–62, Winter 2009
How to Cite
Alpert, M. A., Govindarajan, G., Del Rosario, M. L.E. and Reisin, E. (2009), The Role of the Renin-Angiotensin System in the Pathophysiology, Prevention, and Treatment of Renal Impairment in Patients With the Cardiometabolic Syndrome or Its Components. Journal of the CardioMetabolic Syndrome, 4: 57–62. doi: 10.1111/j.1559-4572.2008.00035.x
- Issue published online: 20 FEB 2009
- Article first published online: 21 JAN 2009
- Manuscript received January 30, 2008; revised March 25, 2008; accepted April 16, 2008
Chronic kidney disease and cardiovascular disease share many risk factors, including hypertension, obesity, and insulin resistance. All of these are components of the cardiometabolic syndrome and are associated with increased risk of morbidity and mortality. One mechanism that links renal injury with the cardiometabolic syndrome is activation of the renin-angiotensin system. Chronic angiotensin II activation promotes development of renal disease through hemodynamic effects and up-regulation of inflammatory cytokines and growth factors. Inhibition of the renin-angiotensin system delays progression of renal disease and improves measures of renal function independent of blood pressure lowering in patients with the cardiometabolic syndrome or its components. Higher doses of renin-angiotensin system inhibitors may provide greater renoprotection in both normotensive and hypertensive patients with the cardiometabolic syndrome. Inhibition of the renin-angiotensin system in patients with risk factors or vascular disease with or without recognized glycemic abnormalities may be a useful strategy for preventing the progression of chronic kidney disease in patients with vascular disease and in those with the cardiometabolic syndrome or its components.