Angiotensin II

Angiotensin II (Giapreza) — Vasoconstrictive Octapeptide

Evidence & Status

  • FDA Approved
  • Strong Human Evidence
  • Strong

At a Glance

The primary bioactive hormone of the renin-angiotensin system, responsible for blood vessel constriction and blood pressure maintenance. Recently FDA-approved as Giapreza for vasodilatory shock, and the central molecular target around which ACE inhibitors and ARBs — two of the most widely prescribed drug classes in medicine — were designed.

Plain English

Researchers study Angiotensin II because it is the master blood pressure-raising hormone of the body, generated through a cascade that the kidneys initiate in response to low blood pressure or blood volume. Scientists are particularly interested in it because it is the target — directly or indirectly — of two of the most widely prescribed drug classes in medicine: ACE inhibitors block its production, and ARBs block its receptor. It has also been approved as an intravenous therapy for critically ill patients with life-threatening drops in blood pressure during septic shock. Understanding Angiotensin II and the renin-angiotensin system is foundational to cardiovascular pharmacology.

Overview

Angiotensin II (Ang II) is the central effector peptide of the renin-angiotensin-aldosterone system (RAAS) — the primary cardiovascular hormone system controlling blood pressure, fluid balance, and vascular resistance. It is produced by ACE-mediated cleavage of angiotensin I (itself cleaved from angiotensinogen by renin). Ang II binds AT1 receptors on vascular smooth muscle causing potent vasoconstriction, stimulates aldosterone secretion from the adrenal cortex, promotes sodium retention in the kidney, and increases vasopressin release. Giapreza (synthetic human Ang II) was FDA-approved in 2017 for vasodilatory shock — severe septic or distributive shock states where excessive vasodilation causes refractory hypotension despite catecholamines and fluids. As a natural vasopressor that works through RAAS rather than adrenergic mechanisms, it provides an additive blood pressure support pathway and may spare catecholamine requirements. Understanding Ang II is essential for contextualizing the Angiotensin-(1-7) entry already in this database — Ang-(1-7) is produced from Ang II by ACE2 cleavage and has opposing (vasodilatory, cardioprotective) effects, completing the RAAS counter-regulatory axis.

Research Summary

GIAPREZA is a product-specific intravenous angiotensin II therapy for adults with septic or other distributive shock. In ATHOS-3, the primary mean arterial pressure response at 3 hours occurred in approximately 69.9% of angiotensin-II-treated patients compared with 23.4% receiving placebo in the studied vasodilatory-shock population. The current GIAPREZA label limits the first-three-hour maximum to 80 ng/kg/min, the maintenance maximum to 40 ng/kg/min, lists no contraindications, and warns about thrombosis with concurrent VTE prophylaxis unless contraindicated. Angiotensin-(1-7) is a separate entity and is not evidence for this record.

Research Areas

  • Vasodilatory shock
  • Septic shock
  • RAAS pharmacology
  • Vasopressor therapy
  • Cardiovascular physiology
  • Kidney function

Safety & Risks

Serious Risks

  • Thrombosis and thromboembolism are labeled risks; use concurrent venous thromboembolism prophylaxis unless contraindicated.
  • The current GIAPREZA label lists no contraindications.

Reported Side Effects

  • Thromboembolism (arterial and venous thromboembolic events at higher rates than controls)
  • Hypertension (if over-titrated)
  • Fungal infections (increased risk observed in trials)
  • Acidosis
United States
GIAPREZA is a U.S. vasoconstrictor used to increase blood pressure in adults with septic or other distributive shock.
United Kingdom
Product- and jurisdiction-specific.
Australia
Product- and jurisdiction-specific.
Canada
Product- and jurisdiction-specific.

Citations & Sources