Angiotensin receptor blockers in hypertension and cardiovascular diseases

Alejandro de la Sierra1

  • 1Hypertension Unit, Department of Internal Medicine, Hospital Clinic, 170-Villarroel, 08036-Barcelona, Spain. asierra@clinic.ub.es

Insights

Angiotensin receptor blockers are effective antihypertensive drugs offering significant cardiovascular protection. These agents demonstrate benefits across various conditions, including heart failure and diabetic renal dysfunction.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Hypertension management is crucial for cardiovascular health.
  • Angiotensin receptor blockers (ARBs) represent a recent class of antihypertensive medications.
  • Growing evidence supports ARBs' benefits beyond blood pressure reduction.

Purpose of the Study:

  • To review the evidence for beneficial effects of ARBs in cardiovascular disorders.
  • To highlight ARBs' impact on mortality, morbidity, and surrogate endpoints.

Main Methods:

  • Systematic review of evidence-based medicine, including controlled studies.
  • Analysis of data from patients with left ventricular dysfunction, heart failure, cerebrovascular disease, and renal dysfunction.

Main Results:

  • ARBs show benefits in patients post-myocardial infarction, with congestive heart failure, and cerebrovascular disease.
  • In type-2 diabetics with renal dysfunction and high-risk hypertensives, ARBs improve outcomes.
  • ARBs prevent type-2 diabetes, reduce left ventricular hypertrophy, decrease proteinuria, improve endothelial function, and lower inflammatory markers.

Conclusions:

  • Angiotensin receptor blockers are effective antihypertensive agents with a favorable efficacy and tolerability profile.
  • ARBs provide significant cardiovascular protection, marking a key advancement in hypertension treatment.
  • These drugs offer a promising option for managing hypertension and associated cardiovascular risks.

Related Concept Videos

Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
Antihypertensive Drugs: Direct Renin Inhibitors01:25

Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
Antihypertensive Drugs: Action of β1 Blockers01:17

Antihypertensive Drugs: Action of β1 Blockers

β1-receptors are primarily located in the heart and kidneys. In cardiac myocytes, these receptors interact with neurotransmitters released by the sympathetic nervous system during heightened activity or danger. As a result, β1-receptors get activated, initiating a series of biochemical processes. Excessive activation of beta receptors due to chronic stress can abnormally increase heart rate and contractility, resulting in high blood pressure or hypertension. To counteract this, β1-blockers...
Antihypertensive Drugs: Types of β-Blockers01:28

Antihypertensive Drugs: Types of β-Blockers

β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and vasodilation. This widens airways and...