The raas in heart failure: An update on clinical trials and opportunities for therapy

Heart failure continues to be a significant health problem worldwide. Despite significant progress in our understanding of the pathophysiology of the condition, its medical management remains a challenge, with a significant 5-year mortality. At the present time, treatment of heart failure has centered on the idea that its clinical manifestations are associated with a derangement of the renin-angiotensin-aldosterone system (RAAS) leading eventually to retention of salt and water. However, the RAAS is no longer viewed as a single endocrine system operating through blood-borne humoral agents but as a more complex system involving a variety of cell types which influence the functions of the cardiovascular system in health and disease. The latter effects, particularly those involving the actions of nitric oxide and endothelial cell function, may open new options for therapy in the future.