title: A review of the use of angiotensin receptor blockers for the prevention of cardiovascular events in patients with essential hypertension without compelling indications.
abstract: OBJECTIVE
  To review the role of angiotensin receptor blockers (ARBs) for the prevention of cardiovascular events in patients with essential hypertension without other compelling indications.
  
  
  METHODS
  Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE and Current Content database (both 1966-November 15, 2012) using the search terms angiotensin receptor blockers (ARBs), azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, hypertension, myocardial infarction, stroke, heart failure, and cardiovascular outcomes. Results were limited to human trials published in English. Citations from articles were also reviewed for additional references.
  
  
  METHODS
  The focus was on clinical trials evaluating cardiovascular end points of ARBs used in patients with essential hypertension without compelling indications.
  
  
  RESULTS
  Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are inconsistent. To date, only candesartan and losartan have shown a significant reduction in cardiovascular morbidity within this sizable subgroup of patients. In the Study on Cognition and Prognosis in the Elderly (SCOPE) trial, candesartan showed a 27.8% reduction in nonfatal stroke versus placebo (95% CI 1.3-47.2; p = 0.04). Moreover, losartan demonstrated a decrease in all cardiovascular events compared to atenolol in the Cardiovascular Morbidity and Mortality in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study (RR 0.87; 95% CI 0.77-0.98; p = 0.021).
  
  
  CONCLUSIONS
  Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive. More studies are needed before ARBs can be routinely recommended as first-line therapy for hypertension management in patients without other compelling indications.
authors.affiliation: Massachusetts College of Pharmacy and Health Sciences, MCPHS University, Boston, MA, USA. kathy.zaiken@mcphs.edu
authors.forename: Kathy
authors.initials: K
authors.lastname: Zaiken
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Hudd
authors.forename: Judy W M
authors.initials: JW
authors.lastname: Cheng
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D057911:Angiotensin Receptor Antagonists