PAPEL DEL SISTEMA RENINA-ANGIOTENSINA-ALDOSTERONA EN LA HIPERTENSIÓN ARTERIAL: Role of the Renin–Angiotensin–Aldosterone System in Arterial Hypertension

Caroline Andrea Grissell Zavaleta Olortegui; Bryan Jhosue Zavaleta Aguirre; Tatiana Lizeth Vivar Alva; Bradly Aramel Segura Acosta; Jorge Luis Ramirez Lopez; Rafael Roberto Beltrán Osorio

doi:10.57188/ricsa.2025.035

Authors

Zavaleta O. Caroline ESTUDIANTE DE MEDICINA HUMANA, UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0009-0005-2392-3355 (unauthenticated)
Bryan J. Zavaleta ESTUDIANTE DE MEDICINA DE LA UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0009-0000-9433-4906 (unauthenticated)
Vivar A. Tatiana ESTUDIANTE DE MEDICINA DE LA UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0000-0001-6868-7425 (unauthenticated)
Aramel S. Acosta ESTUDIANTE DE MEDICINA DE LA UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0009-0006-0689-7711 (unauthenticated)
Ramirez L. Jorge ESTUDIANTE DE MEDICINA DE LA UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0000-0002-2029-2560 (unauthenticated)
Beltrán O. Rafael MÉDICO DOCENTE DE LA UNIVERSIDAD NACIONAL DEL SANTA https://orcid.org/0000-0001-6464-0697 (unauthenticated)

DOI:

https://doi.org/10.57188/ricsa.2025.035

Keywords:

Hypertension; Renin–Angiotensin System; Biomarkers; Molecular Diagnostic Techniques (Source: DecCS-BIREME)

Abstract

The role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension (HTN), its link to cardiovascular damage, and advances in diagnosis and treatment are analyzed. The RAAS is involved in sustained vasoconstriction, inflammation, oxidative stress, and cardiovascular remodeling. Its chronic activation promotes the progression of HTN. Technologies such as Lab-on-a-Chip, POCT, and liquid biopsies, together with genetic biomarkers, have improved early diagnosis and therapeutic personalization. Although RAAS inhibitors remain key, new therapies targeting alternative pathways are being explored. Current knowledge allows for a more precise and personalized approach to the management of HTN.

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References

1. Su C, Xue J, Ye C, Chen A. Role of the central renin–angiotensin system in hypertension. Int J Mol Med. 2021;47(6):95. doi:10.3892/ijmm.2021.4928

2. Ciau-Solís N, Betancur-Ancona D. Sistema renina-angiotensina en patologías cardiovasculares: papel en la hipertensión arterial. J Negat No Posit Results [Internet]. 2021 [citado 3 Jul 2025];6(1):163–76. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2529-850X2021000100010

3. González-Villalva A, Morales-Ricardes G, Rojas-Lemus M, et al. El endotelio sano y su disfunción en el riesgo cardiovascular. Rev Fac Med (Méx) [Internet]. 2023 [citado 3 Jul 2025];66(6):37–52. Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0026-17422023000600037

4. Gamboa AR. Fisiología de la hipertensión arterial esencial. Acta Med Peru [Internet]. 2006 [citado 3 Jul 2025];23(2):76–82. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-59172006000200006

5. Organización Mundial de la Salud. Hipertensión. Ginebra: OMS; 2023. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/hypertension

6. Takeda Y, Demura M, Yoneda T. Epigenetic regulation of the renin–angiotensin–aldosterone system in hypertension. Int J Mol Sci [Internet]. 2024 [citado 3 Jul 2025];25(15):8099. Disponible en: https://www.mdpi.com/1422-0067/25/15/8099

7. Liu X, Yang M, Gregory M, McDowell G. Plasma biomarkers for hypertension-mediated organ damage detection: A narrative review. Biomedicines [Internet]. 2024;12(5):1071. Disponible en: https://www.mdpi.com/2227-9059/12/5/1071

8. Montezano AC, Touyz RM. Molecular mechanisms of hypertension: Reactive oxygen species in the vasculature. Hypertension. 2012;60(5):1106–15. doi:10.1161/HYPERTENSIONAHA.112.197368

9. Montezano AC, Nguyen Dinh Cat A, Rios FJ, Touyz RM. Angiotensin II and vascular injury. Curr Hypertens Rep. 2014;16(6):431. doi:10.1007/s11906-014-0431-2

10. Poznyak AV, Bharadwaj D, Prasad G, et al. Renin–angiotensin system in pathogenesis of atherosclerosis and treatment of CVD. Int J Mol Sci [Internet]. 2021;22(13):6702. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34206708/

11. Fountain JH, Kaur J, Lappin SL. Physiology, Renin–Angiotensin System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls; 2023. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK470410/

12. Shanks J, Ramchandra R. Angiotensin II and the cardiac parasympathetic nervous system in hypertension. Int J Mol Sci. 2021;22(22):12305. doi:10.3390/ijms222212305

13. Martyniak A, Drożdż D, Tomasik PJ. Classical and alternative pathways of the renin–angiotensin–aldosterone system in hypertension and obese adolescents. Biomedicines. 2024;12(3):620. doi:10.3390/biomedicines12030620

14. Goorani S, Hypertension: A continuing public healthcare issue. Int J Mol Sci. 2024;26(1):123. doi:10.3390/ijms26010123

15. Prieto MC, Gonzalez AA, Visniauskas B, Navar LG. The evolving complexity of the collecting duct renin–angiotensin system in hypertension. Nat Rev Nephrol. 2021;17(7):481–92. doi:10.1038/s41581-021-00414-6

16. Paudel P, Prevalence of hypertension in a community. JNMA J Nepal Med Assoc. 2020;58(232):1011–7. doi:10.31729/jnma.5316

17. Mills KT, et al. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. doi:10.1038/s41581-019-0244-2

18. Georgianos PI, Agarwal R. Resistant hypertension in dialysis: Epidemiology, diagnosis and management. J Am Soc Nephrol. 2024;35(4):505–14. doi:10.1681/ASN.0000000000000315

19. Litwin M, Kułaga Z. Obesity, metabolic syndrome and primary hypertension. Pediatr Nephrol. 2021;36(4):825–37. doi:10.1007/s00467-020-04579-3

20. Bludorn J, Railey K. Hypertension guidelines and interventions. Prim Care. 2024;51(1):41–52. doi:10.1016/j.pop.2023.07.002

21. Boulestreau R, et al. Malignant hypertension: Current perspectives and challenges. J Am Heart Assoc. 2022;11(7):e023397. doi:10.1161/JAHA.121.023397

22. Ojangba T,. Lifestyle reform, adherence and related factors in hypertension control: A review. J Clin Hypertens. 2023;25(6):509–20. doi:10.1111/jch.14653

23. Fibben K, Williams EK, Roback JD, Lam WA, Alter DN. From Lab-on-a-Chip to Lab-on-a-Chip-in-the-Lab: A perspective for clinical laboratory microtechnologists. Lab Chip [Internet]. 2025;25(11):2566–77. Disponible en: https://pubs.rsc.org/en/content/articlelanding/2025/lc/d4lc00614c

24. Herd GCE, Musaad SMA. Point-of-care testing in rural and remote settings to improve outcomes: New Zealand experience. Arch Pathol Lab Med. 2021;145(3):327–35. doi:10.5858/arpa.2020-0100-RA

25. Merritt CR. Liquid biopsy–based biomarkers of inflammatory nociception in male rats. Front Pharmacol. 2022;13:943551. doi:10.3389/fphar.2022.943551

26. Maeregu Woldeyes A, et al. Cluster analysis of angiotensin biomarkers to identify antihypertensive drug treatment in population studies. BMC Med Res Methodol. 2023;23(1):149. doi:10.1186/s12874-023-01858-3

27. Santos RAS. The ACE2/Ang-(1–7)/Mas axis: A novel pathway in the renin–angiotensin system. Hypertension. 2013;61(4):780–5. doi:10.1161/HYPERTENSIONAHA.111.00915

28. Ferdinand KC. Efficacy and safety of firibastat in overweight hypertensive patients: Phase 2 study. Lancet. 2019;394(10205):103–11. doi:10.1016/S0140-6736(19)31276-3

29. Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S. Endothelial dysfunction as a target for prevention of cardiovascular disease. Diabetes Care. 2009;32(Suppl 2):S314–21. doi:10.2337/dc09-S336

30. Martyniak A, Tomasik PJ. A new perspective on the renin–angiotensin system. Diagnostics [Internet]. 2022;13(1):16. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36611307/

Role of the Renin–Angiotensin–Aldosterone System in Arterial Hypertension