REZUMAT
Antagonizarea sistemului renina-angiotensina a devenit in ultimii ani o abordare terapeutica de succes, avind ca rezultat scaderea mortalitatii globale si cardiovasculare, atit in cazul pacientilor cu insuficienta cardiaca, cit si in cazul celor cu infarct miocardic. Numeroase studii clinice au stabilit valoarea terapiei cu inhibitori ai enzimei de conversie a angiotensinei la acesti pacienti. Studii clinice mai recente compara terapia combinata (inhibitori ai enzimei de conversie a angiotensinei cu antagonisti ai receptorilor AT 1 ai angiotensinei II) cu monoterapiile respective la pacientii cu infarct miocardic si la cei cu insuficienta cardiaca. in contrast cu cele mai recente doua studii care au inclus pacienti cu insuficienta cardiaca (CHARM-Added si Val-HeFT), in care terapia combinata si-a dovedit eficienta in scaderea mortalitatii si morbiditatii cardiovasculare, trialul VALIANT nu a reusit sa demonstreze superioritatea terapiei combinate la pacientii cu infarct miocardic acut complicat cu insuficienta cardiaca la debut. Citeva studii experimentale si clinice au asociat terapia cu antagonisti ai receptorilor AT 1 ai angiotensinei II cu un risc crescut de aparitie a infarctului miocardic, dar mai multe meta-analize riguroase au infirmat aceasta ipoteza. Dubla antagonizare a sistemului renina-angiotensina si-a dovedit efectul benefic in ameliorarea functiei ventriculare stingi, fara a creste mortalitatea globala, mortalitatea si morbiditatea cardiovasculara.

ABSTRACT
Blockade of the renin-angiotensin system has become one of the most successful therapeutic approaches in recent years, leading to a decrease in cardiovascular morbidity and mortality in patients with chronic heart failure as well as in patients with myocardial infarction. Multiple well-known randomized clinical trials have established the value of the angiotensin-converting enzyme inhibitors in these patients. Several more recent trials have compared combination therapy with angiotensin receptor blockers and angiotensin-converting enzyme inhibitors with the respective monotherapies in patients with MI and in patients with chronic heart failure. In contrast to the most recent trials involving patients with chronic heart failure (CHARM-Added and Val-HeFT) in which dual renin-angiotensin system blockade was shown to be beneficial in terms of cardiovascular morbidity and mortality, VALIANT trial failed to demonstrate the superiority of combination therapy in improving survival in patients with acute myocardial infarction complicated with heart failure. Some experimental and clinical studies associate angiotensin II AT1 receptor blockers therapy with an unexplained increase in myocardial infarction, but several rigorous meta-analyses did not confirm this hypothesis. The dual renin-angiotensin system blockade has proved its beneficial effect on the improvement of the left ventricular function, without increasing all-cause mortality, cardiovascular mortality and morbidity.