Il sistema renina-angiotensina-aldosterone, l'enzima di conversione dell'angiotensina I e gli ACE-inibitori. Prospettiva storica e recenti acquisizioni

The renin-angiotensin-aldosterone system (RAAS) is committed to the regulation of circulatory homeostasis. This system, present in the majority of animal species, is constituted by several elements which behave as effectors able to increase their levels in response to the reduction of the intravascular volume and to the decrease of the renal perfusion. In turn, RAAS is regulated by a number of mechanisms. In our review a historical view precedes the description of the major functions of RAAS, i.e. the regulation of arterial pressure and the control of the hydroelectrolytic homeostasis. The evolution of the achievements about the angiotensin I converting enzyme is reviewed and the currently investigated relationship between RAAS and hemostatic system is assessed. The historical perspective of this review is useful to follow the key passages leading from clinical research to evidence-based therapeutic applications, in particular to the development of ACE-inhibitors. The evaluation of the rationale of ACE-inhibitors therapy in the treatment of arterial hypertension, acute myocardial infarction, heart failure, and diabetic nephropathy, and a discussion of the angiotensin receptor blockers, close the review.