Cardiorenal protection during chronic renin–angiotensin–aldosterone system suppression: evidences and caveats

Blocking the renin-angiotensin-aldosterone system (RAAS) has widely shown to be good for the protection of both cardiovascular and renal systems. A large number of trials have demonstrated clear benefits of using angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) to treat patients with established cardiovascular and renal disease during the last decades. Even more, simultaneous protection of cardiovascular and renal system with RAAS blockade has also been shown. However, some caveats of this therapy as the effectiveness lack in long-term, hyperkalaemia risk in patients with chronic kidney disease or aldosterone and albuminuria breakthrough limit their use, lead that new therapeutic strategies are needed for the RAAS blockade. At this time, new horizons are opened to manage the RAAS blockade in the cardiorenal disease through using the positive combination of an ACEi or an ARB plus and aldosterone antagonist, renin inhibitors, or other forms of blockade using new members as LCZ696.