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Angiotensin II receptor blockers and cardiovascular outcomes: what does the future hold?
1State University of New York Downstate, College of Medicine, New York 10118, USA. michaelwebermd@cs.com
Insights
Angiotensin-converting enzyme (ACE) inhibitors and ARBs effectively lower blood pressure and offer cardiovascular protection. Ongoing trials will clarify if ARBs provide similar or greater benefits than ACE inhibitors, impacting future drug choices.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Nephrology
Background:
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are established treatments for hypertension.
- ACE inhibitors demonstrate vasculoprotective effects in patients with heart failure, post-myocardial infarction, and nephropathy.
- The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in cardiovascular regulation.
Purpose of the Study:
- To evaluate the accumulating evidence for the long-term clinical benefits of ARBs in cardiovascular disease.
- To compare the vasculoprotective properties of ARBs with those of ACE inhibitors.
- To investigate the potential of combined ARB and ACE-I therapy for enhanced cardiovascular protection.
Main Methods:
- Review of ongoing and completed large-scale prospective trials investigating ARBs.
- Analysis of clinical outcomes related to morbidity and mortality in patients with hypertension, heart failure, diabetes, acute myocardial infarction, and vascular disease.
- Exploration of studies examining combination therapy with ARBs and ACE inhibitors.
Main Results:
- ACE inhibitors and ARBs are effective in lowering blood pressure.
- Evidence suggests ARBs may offer long-term clinical outcome improvements comparable to ACE inhibitors.
- Further research is needed to confirm the extent of ARB vasculoprotective effects and the benefits of combined RAAS blockade.
Conclusions:
- Both ACE inhibitors and ARBs are vital in managing cardiovascular risk by targeting the RAAS.
- ARBs show promise for similar or superior vasculoprotective benefits compared to ACE inhibitors, with excellent tolerability.
- Combination therapy with ARBs and ACE inhibitors is an area of active investigation for potentially greater cardiovascular protection.
Abstract:
The ability of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to lower blood pressure (BP) is well established. ACE inhibitors (ACE-Is) have also been shown to improve the prognosis of a broad range of patients at high cardiovascular risk, including those with heart failure, post-myocardial infarction (MI), and nephropathy. These benefits suggest that interrupting the renin-angiotensin-aldosterone system (RAAS) with ACE-Is has a widespread vasculoprotective effect, provided that BP is also adequately controlled. Evidence that RAAS blockade by ARBs also improves long-term clinical outcomes in patients with cardiovascular disease has started to accumulate, and will be tested further during the coming years as a number of large-scale, prospective trials are completed. These trials are investigating the long-term protective effects of ARBs on morbidity and mortality in patients with hypertension, heart failure, diabetes mellitus, acute MI, or established vascular disease. The results should establish the extent to which ARBs exhibit the vasculoprotective properties demonstrated by ACE-Is in patients at high cardiovascular risk. If ARBs are found to provide benefits that are similar to, or even greater than ACE-Is, it may have important implications for drug selection, given the excellent tolerability of ARBs. Some studies are also investigating whether more extensive RAAS blockade using a combination of an ARB and an ACE-I will offer even greater protection than either agent alone.