Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sokol, S. I.
Right arrow Articles by Foody, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sokol, S. I.
Right arrow Articles by Foody, J. M.
Related Collections
Right arrow Endocrine
Right arrow All Clinical trials
Right arrow All Cerebrovascular disease/Stroke
Right arrow Cardiac
Right arrow Infarction
NEUROLOGY 2004;63:208-213
© 2004 American Academy of Neurology
Views & Reviews

Modulation of the renin-angiotensin-aldosterone system for the secondary prevention of stroke

S. I. Sokol, MD, E. L. Portnay, MD, J. P. Curtis, MD, M. A. Nelson, MD, P. R. Hebert, PhD, J. F. Setaro, MD and J. M. Foody, MD

From the Section of Cardiovascular Medicine (Drs. Sokol, Portnay, Curtis, Hebert, Setaro, and Foody), Department of Internal Medicine (Dr. Nelson), Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT.

Address correspondence and reprint requests to Dr. J.M. Foody, Yale University School of Medicine, 3FMP, New Haven, CT 06520-8025; e-mail: joanne.foody{at}yale.edu

Recurrent stroke is a major public health concern and new treatment strategies are needed. While modulation of the renin angiotensin aldosterone system (RAAS) has proven effective in reducing recurrent cardiac events, its role in preventing recurrent cerebrovascular events remains unclear. RAAS is both a circulating and tissue based hormonal system that regulates homeostasis and tissue responses to injury in both the CNS and the periphery, via the activity of angiotensin II (Ang II). Vascular and hematologic effects induced by Ang II including endothelial dysfunction, vascular structural changes, inflammation, hemostasis, and fibrinolysis are increasingly linked to the occurrence of cerebrovascular events. Animal models have shown that RAAS modulation may be protective in cerebrovascular disease. The HOPE and LIFE trials support the role of blood pressure independent mechanisms of RAAS modulation for improving outcomes in a broad range of patients with cardiovascular disease but do not specifically address recurrent stroke prevention. PROGRESS, a trial of secondary stroke prevention, demonstrates that blood pressure reduction with a combination strategy including the routine use of ACE inhibitors prevents recurrent stroke. Current evidence suggests that the RAAS plays an important role in the development and progression of cerebrovascular disease. Modulation of the RAAS holds promise for the secondary prevention of stroke, however, ongoing clinical trials will better define the exact role of ACE inhibitor and angiotensin II Type 1 receptor blocker therapy in stroke survivors.

Received December 10, 2003. Accepted in final form March 1, 2004.




This article has been cited by other articles:


Home page
 J CARDIOVASC PHARMACOL THERHome page
S. A. Saha, J. Molnar, and R. R. Arora
Tissue ACE Inhibitors for Secondary Prevention of Cardiovascular Disease in Patients With Preserved Left Ventricular Function: A Pooled Meta-analysis of Randomized Placebo-controlled Trials
Journal of Cardiovascular Pharmacology and Therapeutics, September 1, 2007; 12(3): 192 - 204.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2004 by AAN Enterprises, Inc.