The Pleiotropic Effects of Angiotensin Receptor Blockers

Abstract

The angiotensin receptor blockers (ARBs) are very effective and safe antihypertensive drugs. They exert their antihypertensive effect through blockage of the angiotensin II, type 1 receptor and quite possibly through stimulation by angiotensin II of the unoccupied type 2 receptor. Besides hypertension, the ARBs have been found recently to be of value in the treatment of heart failure and diabetic nephropathy. In addition, ARBs have emerged lately as being very effective and perhaps superior to other antihypertensive drugs in the prevention of de novo or recurrent strokes. Other actions that may account for their stroke-protective effects include their antiatherogenic, antidiabetic, antiplatelet aggregating, hypouricemic, and atrial antifibrillatory actions. All these actions make the ARBs a true pleiotropic class of drugs. Each of the foregoing effects will be discussed briefly in this concise review.

Inflammation markers and prediction of post-stroke vascular disease recurrence: The MITICO study

“…The pleiotropic effects of the drugs used have been highlighted as the possible mechanism underlying the effectiveness; their anti-inflammatory mechanism being the common factor among them [11,15,16]. This inflammatory hypothesis prompted us to design the MITICO study in order to evaluate the prognostic value of markers of inflammation on vascular disease recurrence in patients who had suffered an ischemic stroke.…”

Dual Renin-Angiotensin-Aldosterone Blockade: Promises and Pitfalls

“…In contrast to ACE inhibitors, the ARBs block the effects the Ang II produced by other enzymes as well, like chymase, which escape the ACE. In addition, the ARBs being highly selective for the AT1 receptor allow the Ang II to be attached and stimulate its other free receptor (AT2), resulting in a dual beneficial, vasodilating, and antiremodeling cardiovascular effect [11]. As was demonstrated from the pharmacodynamic actions of the various RAAS blockers, there were good theoretical reasons for the combination of two RAAS blockers for a greater RAAS blockade and better clinical outcomes in patients with hypertension and other cardiovascular diseases.…”

Blood Pressure Effects of High-Dose Amlodipine-Benazepril Combination in Black and White Hypertensive Patients Not Controlled on Monotherapy

“…[2][3][4][5][6] ACE inhibitors and ARBs are drugs with proven cardioprotective, renoprotective, and cerebroprotective properties. [21] However, certain populations, like AfricanAmericans, are resistant to drugs that block the renin-angiotensin-aldosterone system [RAAS], like ACE inhibitors and ARBs given as monotherapy, [22,23] because these drugs exert their major antihypertensive effects through the blockade of RAAS, and Black patients are usually low-renin and volume-dependent hypertensive subjects. [24] Several clinical trials have shown that the combination of ACE inhibitors with CCBs increases their hypotensive potency [11][12][13][14][15][16][17]25] because of a synergistic effect of inhibition of RAAS and a direct arterial dilatory effect, which is independent of RAAS inhibition.…”