Efficacy of Angiotensin Receptor Blockers in Cardiovascular Disease

Abstract

The cardiovascular continuum describes the progression of pathophysiologic events from cardiovascular risk factors to symptomatic cardiovascular disease (CVD) and life-threatening events. Pharmacologic intervention early in the continuum may prevent or slow CVD development and improve quality of life. The renin-angiotensin-aldosterone system (RAAS) is central to the pathophysiology of CVD at many stages of the continuum. Numerous clinical trials of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have shown that RAAS blockade provides benefits to patients across the continuum. ARBs are as effective as ACE inhibitors in the treatment of hypertension; however tolerability and adherence to therapy appear to be improved with ARBs. Large clinical trials have shown that ARBs may provide therapeutic benefits beyond blood pressure control in patients with diabetes, heart failure or at risk of heart failure following a myocardial infarction. In addition, ARBs have been shown to provide protective effects in patients with impaired renal function or left ventricular hypertrophy. Additional clinical trials are ongoing to further characterize the role of ARBs in CVD management.

Year-Long Antihypertensive Therapy With Candesartan Completely Prevents Development of Cardiovascular Organ Injuries in Spontaneously Hypertensive Rats

“…28) Therefore, antihypertensive drugs suppressing the RAAS, such as ACE inhibitors and ARBs, may be expected to protect cardiovascular organs from hypertensive injury independent of their effects on blood pressure. 15,16) It has been pointed out that the growth of cardiovascular cells is enhanced in SHR and that hypertrophy of cardiovascular tissues and organs develops before blood pressure elevation. [29][30][31][32] In the present study, the long-term therapy with CS prevented the increase in left ventricular mass and fibrosis of left ventricular tissue.…”

“…15,16) The purpose of this study was to evaluate if lifelong antihypertensive therapy with an ARB can completely prevent the development of cardiovascular organ injury in SHR.…”

Hypertension Therapeutics Update: A Brief Clinical Summary on Azilsartan, Cilnidipine and Nebivolol

“…In general, ARBs have a long track record of safety, efficacy, and target organ protection in hypertension while providing considerable freedom from adverse effects. 3 Azilsartan is a new ARB indicated for the treatment of hypertension. It has been proposed that azilsartan due to its pharmacological and pharmacodynamic properties is more potent and powerful in comparison to other ARBs given in comparable doses.…”

Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction

“…The RAAS plays a key role in the pathophysiology of HF by controlling cardiovascular, renal and adrenal function by regulating body fluids, electrolyte balance and arterial pressure [179]. Renin, released in the kidney converts angiotensinogen into angiotensin I (AngI), which is then converted to AngII by angiotensin-converting enzyme (ACE) [180].…”