Summary

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• Angiotensin II (Giapreza) is a potent vasoconstrictor used to manage hypotension, particularly in adults with septic or other distributive shocks where traditional vasopressors have failed or are required in high doses.
• Five systematic reviews/meta-analyses were reviewed for this analysis.
• Angiotensin II has been found to significantly increase mean arterial pressure (MAP) when compared to catecholamine vasopressors such as norepinephrine, epinephrine, and phenylephrine, potentially reducing the dose required of these traditional vasopressors.
• Safety concerns associated with all vasopressors including angiotensin II were noted across the documents; specifically, thromboembolism was identified as a safety concern for angiotensin II, while catecholamine vasopressors have been linked with splanchnic vasoconstriction and resultant hypoperfusion.
• In specific population usage scenarios where initial treatments like norepinephrine have proven insufficient or ineffective, angiotensin II could be considered a third-line treatment option, according to one study on outcomes related to vasodilatory shock.
• Mortality rates among patients administered with angiotensin II were notably lower in those who had elevated renin levels, indicating that it might be particularly effective within this subgroup.