Summary

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• Giapreza (angiotensin II) is indicated to increase blood pressure in adults with septic or other distributive shock.
• This summary is based on the review of five systematic review(s)/meta-analysis(es). ^[1-5]
• Mean Arterial Pressure Improvement: Angiotensin II (ATII) significantly increases Mean Arterial Pressure (MAP) in patients with vasodilatory shock, with comparable effectiveness to catecholamine vasopressors and fewer adverse effects.
• Mortality and Subgroup Analysis: The ATHOS-3 trial showed mixed results on mortality, with a significant reduction observed in patients with elevated renin levels; a meta-analysis indicated that premorbid use of ACEI/ARB was linked to lower short-term mortality in sepsis patients despite a higher risk of Acute Kidney Injury (AKI).
• Vasopressor Dose Reduction: ATII reduces the required dose of concomitant vasopressors needed to maintain adequate blood pressure in vasodilatory shock patients, according to both the ATHOS-3 trial and a systematic review.
• Thromboembolism: The systematic review identified thromboembolism as a safety concern associated with Angiotensin II (ATII).
• Ischemia: Terlipressin and selepressin were linked with ischemia, as noted in the systematic review.
• Acute Kidney Injury (AKI): A meta-analysis reported a significantly higher risk of AKI in sepsis patients with the premorbid use of ACEI/ARB.
• Adverse Drug Effects: ATII was observed to have fewer adverse effects, including splanchnic vasoconstriction and hypoperfusion, compared to traditional vasopressors.
• Patients with elevated renin levels experienced significantly lower mortality when treated with ATII. In critical care settings, ATII, along with arginine vasopressin and noradrenaline, was effective in maintaining MAP for patients with clozapine-induced hypotension. However, premorbid use of ACEI/ARB in sepsis patients was associated with lower short-term mortality but a higher risk of AKI.