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

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.