Use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy to reduce cardiovascular events in high-risk patients: part 2.
As presented previously in Part 1 of this 2-part article, many long-term clinical trials provide overwhelming evidence of the benefits of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) across the cardiovascular continuum. Trials also indicate additive or synergistic effects of combination therapy in renal disease and heart failure. Part 2, which is presented here, discusses the extensive interaction of the renin-angiotensin system (RAS) with the cellular and molecular pathophysiology of cardiovascular disease and the cross-continuum effects of ARBs and ACE inhibitors, which raises the possibility that RAS inhibition can offer protection in high-risk patients who do not have symptoms. Although trial evidence supports the effectiveness of monotherapy, the benefits of combined ACE inhibitor/ARB therapy in high-risk patients await confirmation. Ongoing clinical research will provide new and important information regarding the efficacy of specific combination (ACE inhibitor/ARB) therapies.
Bommer
William J
WJ
University of California Davis Medical Center, Sacramento, 95817, USA. william.bommer@ucdmc.ucdavis.edu
D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D004195:Disease Models, Animal; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors