Clinician’s Brief revisits RAAS suppression with Dr. Luther
Bottom line
Clinician’s Brief has published a sponsored podcast episode featuring internal medicine specialist Linda E. Luther, DVM, MVSc, DACVIM, on manipulation of the renin-angiotensin-aldosterone system, or RAAS, in small animal practice. The discussion centers on a familiar clinical issue for general practitioners: when and how to use RAAS-suppressing therapies, including ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists, in dogs and cats with conditions such as proteinuria, systemic hypertension, and congestive heart failure. A related March 2026 Clinician’s Brief article by Luther notes that chronic RAAS activation can worsen cardiac disease, hypertension, and proteinuria, and highlights a shift toward preferential use of ARBs such as telmisartan over ACE inhibitors for some proteinuric dogs. (cliniciansbrief.com)
Why it matters: For veterinary professionals, the value here is less about a new product launch and more about clinical decision support in an area where recommendations continue to evolve. Luther’s review underscores that RAAS suppression is no longer a one-size-fits-all approach: drug class selection depends on the underlying disease, and follow-up matters. The article advises monitoring serum creatinine, potassium, and systolic blood pressure 1 to 2 weeks after starting therapy or changing the dose, reflecting the practical balancing act between renal protection, cardiovascular benefit, and adverse-effect risk in everyday practice. (cliniciansbrief.com)
What to watch: Expect continued discussion around where ARBs, especially telmisartan, fit relative to ACE inhibitors as veterinary guidance on proteinuria and cardiorenal management keeps maturing. (cliniciansbrief.com)
Key facts
- Topic
- Manipulation of the renin-angiotensin-aldosterone system, or RAAS, in small animal practice
- Speaker
- Linda E. Luther, DVM, MVSc, DACVIM
- Species
- Dogs and cats
- Conditions discussed
- Proteinuria, systemic hypertension, and congestive heart failure
- March 2026 article finding
- Chronic RAAS activation can worsen cardiac disease, hypertension, and proteinuria
- Drug classes discussed
- ACE inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists
- Preferred therapy in some dogs
- IRIS and other groups now preferentially recommend an ARB, such as telmisartan, over an ACE inhibitor for dogs with proteinuria
- Monitoring after therapy change
- Recheck serum creatinine, potassium, and systolic blood pressure in 1 to 2 weeks
- Hypertensive cats without proteinuria
- Amlodipine remains the historical first-choice treatment
Clinician’s Brief is spotlighting a bread-and-butter internal medicine topic for small animal teams: manipulation of the renin-angiotensin-aldosterone system. In a sponsored podcast episode brought to you by Zoetis, host Dr. Alyssa Watson speaks with Linda E. Luther, DVM, MVSc, DACVIM, about RAAS suppression, a therapeutic area that touches chronic kidney disease, proteinuria, feline hypertension, and canine heart disease. The episode extends a broader educational push around how veterinarians use RAAS-targeting drugs in practice. (zoetisus.com)
The timing fits with a newer Clinician’s Brief expert article by Luther, published in March 2026, that lays out current thinking on RAAS suppression in dogs and cats. In that piece, Luther describes RAAS as a protective physiologic response in the short term, but one that can become maladaptive with chronic activation, contributing to systemic hypertension, cardiac remodeling, and proteinuria. That framing is consistent with the broader veterinary literature, which has long described chronic RAAS activation as a driver of cardiovascular and renal injury rather than just a marker of disease. (cliniciansbrief.com)
The practical takeaway is that RAAS manipulation is increasingly nuanced. Luther’s article says ACE inhibitors such as enalapril and benazepril have historically been recommended for proteinuric dogs and cats, but notes that IRIS and other groups now preferentially recommend an ARB, such as telmisartan, over an ACE inhibitor for dogs with proteinuria. The same article also places RAAS suppression within chronic management of congestive heart failure in dogs, while acknowledging that cardiology recommendations are not fully uniform. In cats with systemic hypertension without proteinuria, amlodipine remains the historical first-choice treatment, showing that RAAS-targeting drugs are important, but not automatically first-line in every hypertensive patient. (cliniciansbrief.com)
That nuance matters because RAAS suppression can help, but it also requires monitoring and case selection. Luther advises rechecking serum creatinine, potassium, and systolic blood pressure within 1 to 2 weeks after starting therapy or increasing the dose. The article also points out that some common interventions, including furosemide and dietary sodium restriction, can stimulate the RAAS, which helps explain why treatment plans in cardiac and renal patients can become clinically complex. (cliniciansbrief.com)
Outside Clinician’s Brief, veterinary experts have continued to emphasize the same theme. In a 2023 dvm360 interview, cardiologist Darcy Adin described RAAS activation as appropriate in declining heart function initially, but harmful when chronically overactivated in congestive heart failure, reinforcing the rationale for suppression strategies. Meanwhile, review literature in the Journal of Veterinary Internal Medicine has highlighted ongoing questions around incomplete suppression and “aldosterone breakthrough,” where hormone levels can rise despite therapy, suggesting there is still room for refinement in how these drugs are used. (dvm360.com)
Why it matters: For veterinary professionals, this story is really about clinical translation. RAAS manipulation is common enough to feel routine, but the evidence base is still evolving, especially around drug choice, sequencing, and disease-specific goals. The shift toward ARBs in some proteinuric dogs, the continued role of amlodipine in many hypertensive cats, and the mixed consensus around heart failure protocols all point to a more individualized approach. For general practitioners, that means reviewing older habits, tightening follow-up monitoring, and being ready to explain to pet parents why similar-looking cardiorenal patients may not receive the same RAAS-directed plan. (cliniciansbrief.com)
The Zoetis sponsorship is also notable in a broader industry sense, not because a product announcement appears tied to the episode, but because it reflects how continuing education and sponsored media remain major channels for updating frontline clinicians on nuanced therapeutic areas. Zoetis’ veterinary education platform and clinician-support materials show the company’s ongoing investment in professional education, even when the immediate content is disease-state focused rather than brand centered. (zoetisus.com)
What to watch: The next development to track is whether future guideline updates, new comparative studies, or wider clinical adoption further solidify ARBs as preferred therapy in selected proteinuric patients, and whether additional evidence clarifies how aggressively veterinarians should pursue multi-drug RAAS suppression in cardiorenal disease. (cliniciansbrief.com)