Vascular and cardiac benefits of angiotensin receptor blockers.
Angiotensin II not only is a vasoconstrictor, but it also affects cell growth and apoptosis, inflammation, fibrosis, and coagulation. Blockade of the renin-angiotensin system, either with inhibitors of the generation of angiotensin (angiotensin-converting enzyme [ACE] inhibitors) or with blockers of angiotensin receptors, reduces blood pressure and inhibits other pathophysiological actions. These other effects provide benefits in coronary heart disease, heart failure, diabetic nephropathy, and stroke beyond blood pressure reduction. These benefits were first demonstrated with ACE inhibitors. However, the mechanism of action of angiotensin receptor blockers, which block angiotensin II stimulation at the angiotensin type 1 receptor but not at the type 2 receptor, may have advantages, particularly for endothelial dysfunction and vascular remodeling, as well as cardiac and renal protection. Recent multicenter trials suggest that ACE inhibitors and angiotensin receptor blockers may reduce morbidity and mortality associated with cardiovascular and renal disease beyond blood pressure reduction. Several studies with different angiotensin receptor blockers, including comparisons with ACE inhibitors, are under way, and should provide further guidance for their clinical use.
Schiffrin
Ernesto L
EL
Canadian Institutes of Health Research Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montreal, University of Montreal, Montreal, Québec, Canada. schiffrin@ircm.qc.ca
D057911:Angiotensin Receptor Antagonists; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000503:physiopathology*; D002319:Cardiovascular System / Q000187:drug effects* / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007674:Kidney Diseases / Q000188:drug therapy / Q000503:physiopathology*; D011945:Receptors, Angiotensin / Q000502:physiology* / Q000627:therapeutic use
D057911:Angiotensin Receptor Antagonists; D011945:Receptors, Angiotensin