Angiotensin receptor blockers versus angiotensin-converting enzyme inhibitors: where do we stand now?

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Cardiovascular disease progresses from risk factors like hypertension to atherosclerosis, organ damage, heart failure, and stroke.
• Renin-angiotensin-aldosterone system (RAAS) blockade, via ACE inhibitors or ARBs, offers benefits throughout this continuum.
• ACE inhibitors have demonstrated cardiovascular event reduction, but ARB data is limited in this area.

Purpose of the Study:

• To review the established benefits of RAAS blockade in cardiovascular disease.
• To highlight the need for further research on ARBs and RAAS blockade across the cardiorenovascular continuum.
• To introduce insights from trials like ONTARGET and TRANSCEND.

Main Methods:

• Review of existing clinical trial data on ACE inhibitors and ARBs.
• Focus on studies examining effects on atherosclerosis, endothelial function, and target organ damage.
• Analysis of data from high-risk patient populations in trials like ONTARGET and TRANSCEND.

Main Results:

• Both ACE inhibitors and ARBs mitigate endothelial dysfunction and atherosclerosis.
• ACE inhibitors reduce cardiovascular events in coronary artery disease patients.
• Both drug classes protect organs like the heart and kidneys and reduce mortality/morbidity in heart failure.

Conclusions:

• RAAS blockade is beneficial across the cardiovascular disease continuum.
• Further insights into ARB benefits and RAAS blockade are expected from ongoing trials.
• These trials will clarify the role of telmisartan and ramipril in high-risk patients with end-organ damage.