Angiotensin Receptor Blockers in the Management of Hypertension: A Real-World Perspective and Current Recommendations

Abstract

Hypertension represents a major common cardiovascular risk factor. Optimal control of high blood pressure levels is recommended to reduce the global burden of hypertensive-mediated organ damage and cardiovascular (CV) events. Among the firstline drugs recommended in international guidelines, renin-angiotensin-aldosterone system antagonists [angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs)] have long represented a rational, effective, and safe anti-hypertensive pharmacological strategy. In fact, current US and European guidelines recommend ACEi and ARBs as a suitable first choice for hypertension treatment together with calcium channel blockers (CCBs) and thiazide diuretics. Different studies have demonstrated that ARBs and ACEi exert a comparable effect in lowering blood pressure levels. However, ARBs are characterized by better pharmacological tolerability. Most importantly, the clinical evidence supports a relevant protective role of ARBs toward the CV and renal damage development, as well as the occurrence of major adverse CV events, in hypertensive patients. Moreover, a neutral metabolic effect has been reported upon ARBs administration, in contrast to other antihypertensive agents, such as beta-blockers and diuretics. These properties highlight the use of ARBs as an excellent pharmacological strategy to manage hypertension and its dangerous consequences. The present review article summarizes the available evidence regarding the beneficial effects and current recommendations of ARBs in hypertension. The specific properties performed by these agents in various clinical subsets are discussed, also including an overview of their implications for the current COVID-19 pandemic.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…ARBs have a similar antihypertensive efficacy and protective effect as ACEis [554][555][556], albeit with a somewhat different mechanism for RAS inhibition and a smaller RCT database. A difference between ACEis and ARBs is their tolerability profile, with ARBs having a rate of side effects similar to placebo.…”

Network-Based Prediction of Side Effects of Repurposed Antihypertensive Sartans against COVID-19 via Proteome and Drug-Target Interactomes

“…Sartans are antihypertensive drugs that act on the RAAS by targeting the AT1R and activating the AT2R [ 10 ]. Apart from lowering blood pressure, ARBs are associated with lung endothelial protection and inflammation reduction [ 11 ].…”

“…On the other hand, ARBs were engineered as a substitute for patients who could not endure the adverse events of ACE inhibitors. These drugs specifically block the AT1R while augmenting the activation of the AT2R [ 10 ]. Additionally, ARBs can limit inflammation along with endothelial and epithelial dysfunction in various organs.…”

Potential Mechanisms of the Protective Effects of the Cardiometabolic Drugs Type-2 Sodium–Glucose Transporter Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Heart Failure

“…Renin–angiotensin–aldosterone system (RAAS) activation induces vasoconstriction, cardiac hypertrophy, fibrosis, inflammation, vascular smooth muscle cell de-differentiation, and reactive oxygen species production. These actions, largely mediated through the action of the biological effector angiotensin II at the receptor levels, may promote structural remodeling, cardiac and vascular damage, and the development of HF [ 19 , 20 ].…”