Peptide Graded

Angiotensin II

Does Angiotensin II work?

Yes, in a large controlled trial of 344 adults with shock.

AStrong human evidenceFDA approvedas of 2026-10-26

Approval rests on ATHOS-3, a randomized, double-blind, placebo-controlled trial in 344 adults with vasodilatory shock that met its blood-pressure endpoint. That is one trial with a surrogate endpoint, but a regulator accepted it for approval and it is the use the drug is known for, which fits grade A as defined here; no survival benefit has been shown. 45

ATHOS-3 appeared in the New England Journal of Medicine in 2017. It randomized 344 adults with vasodilatory shock to angiotensin II or placebo. All had low blood pressure despite high doses of standard vasopressors. At three hours, 69.9% of the angiotensin II group reached the target blood pressure. With placebo, 23.4% did. Doctors could lower the other vasopressor doses in the treated group. 5

By day 28, 46% of patients on angiotensin II had died, against 54% on placebo. That gap was not statistically significant. The trial was not built to detect a difference in deaths. No later randomized trial has shown a survival benefit. 5

Evidence checklist

  • Randomised controlled trial ATHOS-3, double-blind, placebo-controlled
  • Human study over 100 people ATHOS-3, 344 adults with shock
  • More than one research group One main trial from the maker
  • Clinical outcomes, not surrogate markers Blood pressure target met; no survival gain
  • Human safety data beyond case reports Clot and other events tracked in ATHOS-3

Read the full Angiotensin II page

More on Angiotensin II

Citations

  1. StatPearls: Physiology, renin angiotensin system ncbi.nlm.nih.gov
  2. La Jolla Pharmaceutical: Giapreza product site giapreza.com
  3. Basso 2001, Hypertension: history of the discovery of the renin-angiotensin system pubmed.ncbi.nlm.nih.gov
  4. FDA: Giapreza (angiotensin II) prescribing information, 2017 accessdata.fda.gov
  5. Khanna 2017, NEJM: angiotensin II for the treatment of vasodilatory shock (ATHOS-3) doi.org

Reference information only, not medical advice. Drawn from the Angiotensin II article, fact-checked against the cited sources. No dosing anywhere on this site.