Angiotensin receptor blockers: role in hypertension management, cardiovascular risk reduction, and nephropathy

The renin-angiotensin system (RAS) plays a central pathogenic role in the development of hypertension and associated vascular disorders. However, whether the two main classes of agents that blunt RAS activity-angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)-yield comparable cardioprotective and renoprotective effects in high-risk patients is controversial.

An analysis of several controlled clinical trials provides evidence that, in patients with or without heart failure, ARBs provide protective effects and improvements in prognosis compared with those achieved with ACEIs.

This article describes the critical studies that examine the cardioprotective and renoprotective efficacy of ARBs and identifies the populations and doses at which these agents are most effective.

In the clinical setting, ARBs may be a valuable alternative to ACEI therapy. Because of their tolerability profile, ARBs or ARB combination therapy may be an option for patients susceptible to ACEI-related adverse events.