The role of angiotensin receptor blockers in reducing the risk of cardiovascular disease

Abstract

New approaches to the definition and treatment of hypertension have increased emphasis on reducing overall cardiovascular risk and on targeting the underlying mechanisms of cardiovascular disease. During the past several decades, renin-angiotensin-aldosterone system (RAAS) activation has emerged as an important factor in the pathophysiology of endothelial dysfunction and cardiovascular disease (CVD). Angiotensin-converting enzyme inhibitors (ACEIs) have wellestablished efficacy for treating CVD, but their use may be limited by intolerable side effects, such as cough and angioedema. Angiotensin II receptor blockers (ARBs), a different class of RAAS inhibitors, are considered a viable alternative to ACEIs. Clinical trials have further elucidated the role of ARBs in CVD. This article reviews the mechanism of action of ARBs and selected clinical trials of ARBs in CVD.

Effects of angiotensin II blockade on cardiomyocyte regeneration after myocardial infarction in rats

“…The myocyte cross-sectional area tended to be smaller in losartan treated rats, suggesting inhibitory effects on cardiomyocyte and left ventricular hypertrophy as reported previously in experimental and clinical studies with ARBs. 16–18,30 In addition, the overall increase in cell proliferation after MI, as judged from the amount of all BrdU positive cells in the remote myocardium outside the infarct area, did not differ from sham-operated controls in the losartan treated rats with MI. These effects on post-MI cardiac remodelling and cell proliferation are in agreement with previous studies showing that treatment with ARBs modulates the adverse remodelling of the non-infarcted myocardium after MI.…”

“…In the long term treatment of chronic heart failure following myocardial injury the modulating effects of AT1 receptor blockade on post MI remodelling are considered to be beneficial in reducing the occurrence of adverse cardiac events. 15,18…”

“…In the long term treatment of chronic heart failure following myocardial injury the modulating effects of AT1 receptor blockade on post MI remodelling are considered to be beneficial in reducing the occurrence of adverse cardiac events. 15,18 In summary, the number of BrdU-labelled cardiomyocytes increased markedly in the infarct border zone after coronary artery ligation. The enhanced formation of new cardiomyocytes continued throughout the four-week post MI study period.…”

“…15 Numerous clinical trials after MI and in patients with chronic heart failure have demonstrated benefits of RAS-blockade either with angiotensin-converting enzyme (ACE) inhibitors or angiotensin type 1 (AT1) receptor antagonists in the treatment of these patient groups. [16][17][18] However, cardiovascular morbidity and mortality are still significantly higher than expected in patients with heart failure as compared with normal ageing despite current optimal medical therapy including a RAS-inhibitor and a beta-blocker. Thus, additional treatment strategies are needed to further reduce the excess morbidity in these patients.…”

The Impact of Vitamin D in the Treatment of Essential Hypertension

“…Calcium channel blockers: Dihydropyridines such as amlodipine and nifedipine have specific impact on the vessels and induce a compensatory activation of baroreceptors [ 18 ]; 3. β-adrenoceptor antagonists: Metoprolol and atenolol with selectivity to β 1 -adrenoceptors and propranolol with no selectivity are some of the most common drugs of this class [ 19 ]; 4. Blockers of the renin-angiotensin-aldosterone system (RAAS): The group of angiotensin-converting-enzyme inhibitors (ACEi) includes drugs such as enalapril and captopril [ 20 ], angiotensin II receptor blockers (ARBs) include losartan, azilsartan and valsartan [ 21 ], and 5. Direct renin inhibitors comprise drugs like aliskiren [ 22 ].…”