Abstract Body: Introduction: ACE inhibitors and ARBs are often given for high blood pressure, and protect organs in specific situations, regardless of whether blood pressure improves. Treatment guidelines recommend using RAS blockade in patients with heart failure and diabetic kidney disease, even if not hypertensive. However, we lack a full review of the results when RAS inhibitors are used in non-hypertensive groups. Our review assessed how RAS inhibitors affected patients without hypertension in different diseases.
Hypothesis: The system that includes renin and angiotensin (RAS) can cause organ-specific effects that are not directly tied to blood pressure control. This means that RAS blocker medications can provide organ protection for normotensive patients by targeting tissue RAS, inflammation, and changes in tissue structure caused by fibrosis.
Methods: We followed PRISMA standards to search for research on ACE inhibitor or ARB medicines given to patients who never had hypertension (normotensive), and looked at cardiovascular and renal results.15 studies reviewed (10 RCTs and 5 observational studies) patients with heart failure, normal blood pressure, and diabetic kidney disease. Ejection fraction, kidney function, and mortality statistics were collected from the clinical endpoints. We assessed quality using Cochrane Risk of Bias, and for observational research, we used the Newcastle-Ottawa Scale.
Results: RAS blockade protected multiple organs in patients without high blood pressure. Among patients with HFrEF and normal or reduced BP at baseline, ACE inhibitors and ARBs showed the same life improvements as in hypertensive patients. Among patients with normal blood pressure and microalbuminuria, using RAS blockers slowed the progression of kidney disease (a positive reduction in albuminuria) progression. In one Marfan syndrome study, patients with no high blood pressure derived aortic protection from using an ARB. Although, data did match these benefits, possible influence by other factors was also noted. The research was solid for RCTs (low chance of bias) and backed up by real data.
Conclusions: A key finding is that RAS blockers lower the risk of kidney and heart disease, even without high blood pressure. They provide multiple benefits, these drugs are now recommended for some people with normal blood pressure to prevent damage to the organs. More studies are needed to improve how people are chosen for treatment and to confirm how well this strategy works long-term.