Angiotensin-receptor blockers: revival of the systemic prevention of restenosis?
Restenosis following percutaneous coronary transluminal angioplasty and stenting remains a significant problem, occurring in 15-50% of patients within 6-9 months of the intervention. Several pharmacological approaches to reduce restenosis have been evaluated but to date none have been approved for this indication. Angiotensin II has been implicated in the development of restenosis through several physiologic mechanisms, and thus control of the renin-angiotensin system may be a potential target for its prevention. Although human trials have shown that angiotensin-converting enzyme inhibitors do not reduce the risk of restenosis, early data suggest that the selective AT(1) angiotensin receptor blocker valsartan may be effective in preventing in-stent restenosis in patients with complex lesions.
Wilensky
Robert L
RL
Hospital of the University of Pennsylvania, 3400 Spruce St., 9 Gates, Philadelphia, PA 19104, USA. robert.wilensky@uphs.upenn.edu
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000804:Angiotensin II / Q000502:physiology; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D002986:Clinical Trials as Topic; D023903:Coronary Restenosis / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D006801:Humans; D011945:Receptors, Angiotensin / Q000502:physiology; D015607:Stents / Q000009:adverse effects; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin; D013777:Tetrazoles; D000804:Angiotensin II; D000068756:Valsartan; D014633:Valine