Internal Medicine ·
Review proposes phenotype-guided angiotensin II use in vasodilatory shock
A narrative review outlines clinical and functional phenotypes that may identify patients with vasodilatory shock and relative angiotensin II deficiency. It discusses evidence for blood-pressure and vasopressor effects, but says phenotype-guided strategies require further validation against patient-centered outcomes.
- Review identifies candidate shock phenotypes linked to RAAS dysregulation.
- ATII reports describe blood-pressure restoration and vasopressor-sparing effects.
- Response may be attenuated after recent ARB exposure.
- Phenotype-guided strategies need validation against patient-centered outcomes.
Vasodilatory shock encompasses diverse mechanisms, while vasopressor selection is often empiric, the authors write. This narrative review examines whether renin–angiotensin–aldosterone system dysregulation and relative angiotensin II (ATII) deficiency can help identify patients for targeted ATII therapy. It highlights severe acute kidney injury, cardiac surgery-associated vasoplegia, kidney transplantation, acute respiratory distress syndrome, and recent ACE-inhibitor or angiotensin-receptor-blocker exposure as potentially relevant clinical phenotypes.
The review describes reports of rapid mean arterial pressure restoration and reduced vasopressor requirements after ATII in several selected populations, with signals of improved clinical outcomes. It also notes that response may be attenuated after recent angiotensin-receptor-blocker exposure. The AIMRITE study is presented as a complementary approach: functional phenotyping based on early hemodynamic response after ATII initiation.
The authors propose combining clinical phenotype recognition with early response assessment to inform vasopressor selection, but emphasize that these strategies need further investigation and validation for patient-centered outcomes. This is a narrative review, not a trial establishing comparative efficacy or a validated treatment-selection rule. The article reports no specific funding; its processing charge was funded by Innoviva Specialty Therapeutics, and two authors are employees of the company, which markets Giapreza in the United States.
In practice
For clinicians managing vasodilatory shock, the review identifies severe acute kidney injury, cardiac surgery-associated vasoplegia, kidney transplantation, ARDS, and RAAS-modulating medication exposure as possible clues to relative angiotensin II deficiency. It summarizes reports of rapid mean arterial pressure improvement and vasopressor sparing with angiotensin II in selected populations, while noting potentially attenuated response after recent ARB exposure. This narrative framework is not a validated selection rule; further studies are needed to establish effects on patient-centered outcomes, so it does not support changing practice on its own.
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Critical Care: A clinical framework for phenotype-guided angiotensin II therapy: rethinking RAAS dysregulation and angiotensin II deficiency in vasodilatory shock ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.