The use of angiotensin II type 1 receptor antagonists in the treatment of chronic heart failure against the background of the renin-angiotensin-aldosterone system genetic polymorphisms

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Abstract

Background. The relevance of the search for new drugs for the treatment of chronic heart failure (CHF) is attributable to the high morbidity, high mortality of patients with CHF, as well as the increasing number of multimorbid patients. In the pathogenesis of CHF, an important role is played by the vasoconstrictor and vasodilator effects of tissue neurohormones of the renin-angiotensin-aldosterone system (RAAS), which determine the progression of decompensation of the cardiovascular system in response to antigotensin-II-mediated myocardial remodeling and a decrease in cardiac output.

Objective. Identification of the most significant polymorphic variants of the RAAS genes that determine the effectiveness of therapy for cardiovascular diseases with type 1 angiotensin II receptor blockers (ARBs) based on an analysis of the scientific literature

Methods. During the period from January to September 2023, a search was conducted in the PubMed and Google Scholar databases using the following Keywords heart failure, angiotensin II receptor antagonists, antihypertensive drugs, RAAS gene polymorphisms, angiotensin II, angiotensinogen, aldosterone synthase, angiotensin-converting enzym, single nucleotide poly- morphism (SNP).

Results. ARB receptor blockers, widely used in the treatment of CHF at present, have a positive effect on hemodynamic parameters and ensure the reverse development of left ventricular hypertrophy. Several genetic polymorphisms that may be involved in the pathogenesis of cardiovascular diseases and also alter the pharmacological response to ARB therapy have been described.

Conclusion. Identification of allelic variants of genes encoding components of the RAAS may contribute to a differentiated approach to the selection of individual ARBs, but at present there is not yet a sufficient evidence base to develop any standard panel of polymorphisms to be evaluated for the development of clinical recommendations for personalized selection of drugs of the group under discussion.

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About the authors

Nadezhda V. Izmozherova

Ural State Medical University

Author for correspondence.
Email: nadezhda_izm@mail.ru
ORCID iD: 0000-0001-7826-9657

Dr. Sci. (Med.), Associate Professor, Head of the Department of Pharmacology and Clinical Pharmacology, Chief fExternal Expert in Clinical Pharmacology of the Ministry of Health of the Sverdlovsk Region

Russian Federation, Yekaterinburg

M. A. Grenaderova

Ural State Medical University

Email: nadezhda_izm@mail.ru
Russian Federation, Yekaterinburg

M. A. Shambatov

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0000-0001-7312-415X
Russian Federation, Yekaterinburg

A. A. Popov

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0000-0001-6216-2468
Russian Federation, Yekaterinburg

E. V. Kudryavtseva

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0000-0003-2797-1926
Russian Federation, Yekaterinburg

A. E. Bortnik

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0009-0005-4379-0721
Russian Federation, Yekaterinburg

K. A. Vishneva

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0000-0001-9077-0102
Russian Federation, Yekaterinburg

M. D. Shamilov

Ural State Medical University

Email: nadezhda_izm@mail.ru
ORCID iD: 0009-0009-0197-8354
Russian Federation, Yekaterinburg

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