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The renin-angiotensin-aldosterone system in heart failure for the non-specialist: the past, the present and the future
  1. Christopher Orsborne1,
  2. Parminder S Chaggar1,2,
  3. Steven M Shaw1,2,
  4. Simon G Williams1,2
  1. 1North West Heart Centre, University Hospital of South Manchester, Manchester, UK
  2. 2The University of Manchester, Manchester, UK
  1. Correspondence to Dr Christopher Orsborne, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; Chris.orsborne{at}


Heart failure is one of the major public health challenges facing the Western world. Its prevalence is increasing as the population ages and modern techniques are implemented to manage cardiac disease. In response, there has been a sustained effort to develop novel strategies to address the high levels of associated morbidity and mortality. Indeed, agents that target the renin-angiotensin-aldosterone system (RAAS) have transformed the way in which we manage heart failure. Despite this, mortality in heart failure is poorer than in many malignancies and a large burden of morbidity and recurrent hospitalisation remains. Here, we review the role of RAAS modulation within the field of systolic heart failure. In particular, we provide practical guidance on using current RAAS blockade agents and focus on the recent emergence of new agents that promise additional substantial benefit to those living with left ventricular systolic dysfunction.

  • Angiotensin receptor and neprilysin inhibitor
  • Renin-angiotensin-aldosterone system
  • Angiotensin converting enzyme inhibitors
  • Mineralocorticoid receptor antagonists
  • Beta-blockers

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