[Angiotensin-converting enzyme inhibitors and/or angiotensin II receptors antagonists in the treatment of arterial hypertension].
The renin-angiotensin system (RAS) plays an important role in the development of cardiovascular diseases. The favorable effects of inhibitors of this system are mainly due to a decrease of the production of angiotensin II. Usual association between angiotensin II receptor antagonists (AIIA) and angiotensin-converting enzyme (ACE) inhibitors results of a mutual action on the RAS, but important differences exist. ACE inhibitors demonstrated major benefits in heart failure and in post-infarction. In diabetic patients, ACE inhibitor treatment is associated with nephroprotective effects. In four main studies ACE inhibitors didn't demonstrated superior effect on primary outcome compare to standard antihypertensive treatment (diuretics or beta-blockers). However, in HOPE and PROGRESS studies, ACE inhibitors decrease myocardial infarction incidence, even after arterial pressure adjustment. Can we expect the same effects with the AIIA? Of course a direct comparison would be preferable, but some differences emerge. In a main study, AIIA treatment was compared to a standard antihypertensive treatment. The LIFE trial demonstrated superior benefits with losartan than with beta-blocker atenolol for the same degree of blood pressure reduction in hypertensive patients with left ventricular hypertrophy. Losartan had particularly strong effect on risk for stroke and prevented new-onset diabetes. So we have some data to emit the hypothesis that ACE inhibitors decrease the incidence of myocardial infarction and AIIA the incidence of stroke.
Silance
P G
PG
Service de Cardiologie, C.H.U. Saint-Pierre, U.L.B.
D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*
D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors