title: Angiotensin II receptor antagonists in acute coronary syndromes.
abstract: BACKGROUND
  It is well known that inappropriate or exaggerated activity of the renin-angiotensin system might contribute to the development of systemic hypertension with consequent organ injury and associated increased risk of acute cardiovascular (CV) diseases. This review will discuss evidence form basic research and clinical studies, investigating the efficacy of angiotensin II receptor blockers (ARBs) in the management of acute coronary syndromes (ACS).
  
  
  METHODS
  This narrative review is based on the material found on MEDLINE and PubMed up to June 2013. We looked for the terms 'angiotensin, AT1 receptor, ACE inhibitors' in combination with 'acute coronary syndromes, acute myocardial infarction, pathophysiology'.
  
  
  RESULTS
  Preclinical studies showed relevant protective effects of ARBs to reduce adverse cardiac remodelling in animal models of acute cardiac ischaemia. However, although recommended in Consensus guidelines as a good alternative to angiotensin-converting enzyme inhibitors (ACEIs), clinical studies did not confirm a superior efficacy of the ARBs as compared to ACEIs. As a matter of fact for some authors, these drugs might potentially have deleterious effects increasing the CV risk.
  
  
  CONCLUSIONS
  Emerging evidence from clinical trials suggests that the use of ARBs in ACS might be controversial, and caution should be used for their clinical use to replace ACEIs in ACS.
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Nathan
authors.initials: N
authors.lastname: Artom
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.forename: Franco
authors.initials: F
authors.lastname: Dallegri
authors.forename: Aldo
authors.initials: A
authors.lastname: Pende
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000085962:Angiotensin-Converting Enzyme 2; D002986:Clinical Trials as Topic; D006801:Humans; D007703:Peptidyl-Dipeptidase A / Q000096:biosynthesis; D044139:Receptor, Angiotensin, Type 2 / Q000502:physiology; D043562:Receptors, G-Protein-Coupled / Q000502:physiology; D012307:Risk Factors; D066253:Vascular Remodeling / Q000502:physiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D044139:Receptor, Angiotensin, Type 2; D043562:Receptors, G-Protein-Coupled; D007703:Peptidyl-Dipeptidase A; C000705307:ACE2 protein, human; D000085962:Angiotensin-Converting Enzyme 2
keywords: Acute coronary syndromes; angiotensin II receptor blockers; angiotensin-converting enzyme inhibitors