Pleiotropic effects of angiotensin receptor blockers: addressing comorbidities by optimizing hypertension therapy

The efficacy of angiotensin receptor blockers (ARBs) in the management of hypertension is well established. Whether these agents induce pleiotropic effects that promote the amelioration of vascular disorders independent of blood pressure reduction remains controversial. This review examines preclinical and clinical data that highlight a potentially important role for ARBs in several common vascular disorders, including cardiovascular, cerebrovascular, renal, and metabolic disorders. The preponderance of evidence suggests that some of the benefits derived from ARBs might improve outcomes in these disorders by actions that extend beyond blood pressure reduction. This review also identifies some potentially important differences in the mechanism of action between ARBs and angiotensin-converting enzyme inhibitors that may have clinical significance in the management of vascular diseases.