At a glance
| US product | Giapreza |
|---|---|
| Peptide length | 8 amino acids |
| Clinical setting | Septic or other distributive shock |
| Main receptor | AT1 |
| Major warning | Arterial and venous thrombosis |
Overview
Angiotensin II is part of the renin–angiotensin system that normally helps regulate circulation and sodium balance. The pharmaceutical product Giapreza supplies the active octapeptide directly during severe vasodilatory shock. This intensive-care use differs from chronic hypertension, where medicines often block the same pathway. In shock, clinicians may need an additional mechanism to restore vascular tone despite fluids and other vasopressors. The ATHOS-3 trial demonstrated a rapid pressure response in a selected critically ill population. Improving a hemodynamic measurement is clinically useful, but it should not be described automatically as proof of improved survival or prevention of organ failure in every patient.
How it works
Angiotensin II binds angiotensin receptors, principally AT1 receptors on vascular smooth muscle, causing vasoconstriction and increased systemic vascular resistance. It also promotes aldosterone-related effects in normal physiology. Direct infusion bypasses upstream hormone generation. This mechanism complements catecholamine and vasopressin pathways, but stronger vascular tone can carry thrombotic or ischemic consequences, making circulation and organ perfusion important alongside the displayed blood-pressure value.
A critical-care intervention
Giapreza is indicated to increase blood pressure in adults with septic or other distributive shock. It is delivered as an intravenous infusion in a monitored setting. It does not treat the infectious source itself or replace fluid assessment, antimicrobial therapy when indicated, and management of the underlying shock process.
Supporting sources [1]
The ATHOS-3 endpoint
ATHOS-3 enrolled patients with vasodilatory shock requiring substantial background vasopressor support. More angiotensin II recipients met the prespecified early mean-arterial-pressure response than placebo recipients. That endpoint demonstrates vasopressor efficacy. The study did not establish a statistically definitive overall survival advantage, so claims about mortality should remain qualified.
Supporting sources [2]
Thrombotic risk and competing goals
The label warns about increased arterial and venous thrombotic events and calls for concurrent venous-thromboembolism prophylaxis unless contraindicated. Other vasopressors and shock itself also influence ischemic risk. Clinicians must assess tissue perfusion, organ function, and evolving hemodynamics rather than treating a pressure number in isolation.
Supporting sources [1]
Why give a hormone often blocked in hypertension?
The clinical context is different. Chronic excess vasoconstriction can contribute to hypertension, whereas profound loss of vascular tone in distributive shock can threaten organ perfusion. Replacing an active pressor signal in that emergency does not imply that angiotensin II is appropriate for chronic fatigue, general circulation support, or outpatient wellness.
Reading this profile
Jurisdiction: United States; indications and availability vary by formulation and country.. Molecular class: Synthetic octapeptide vasopressor hormone.
This profile was written with AI-assisted research and checked against the linked sources. It has not been represented as a clinician’s review. Evidence summaries describe the cited studies and products; they do not establish that a separately purchased preparation is equivalent.
Sources & references
Follow the original material. Product labels define specific formulations and uses; trial registration describes a study and does not by itself establish benefit.
- Giapreza — US prescribing information ↗Regulatory source · Checked 2026-10-27
- Angiotensin II for the Treatment of Vasodilatory Shock. ↗Original research · Checked 2026-10-27