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Renin-angiotensin antagonists: therapeutic effects beyond blood pressure control?
1Clinic of Internal Medicine 1, Department of Internal Medicine, University of Genoa School of Medicine, Viale Benedetto XV 6, Genoa, Italy. apende@unige.it
Insights
Renin-angiotensin system blockers offer benefits beyond blood pressure control, aiding physicians in hypertension management. Their safety profile supports early intervention, particularly for cardiovascular risk reduction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension treatment guidelines offer physician flexibility but differ on initial drug choices.
- Achieving adequate blood pressure reduction remains a challenge in the general population.
- Certain antihypertensive drugs may provide cardiovascular event protection independent of blood pressure reduction (effects beyond blood pressure control).
Purpose of the Study:
- To explore the role of renin-angiotensin system antagonists in managing hypertension and associated cardiovascular risks.
- To evaluate the evidence for effects beyond blood pressure control offered by renin-angiotensin system blockers.
- To assess the utility of renin-angiotensin system blockers in early hypertension management and specific cardiovascular situations.
Main Methods:
- Review of preclinical studies on the renin-angiotensin system's role in blood pressure regulation and atherothrombotic processes.
- Analysis of clinical trial data and evidence-based medicine literature regarding antihypertensive drug classes.
- Evaluation of intermediate endpoints like microalbuminuria, left ventricular hypertrophy, and arterial stiffness.
Main Results:
- Preclinical data highlight the renin-angiotensin system's dual role in blood pressure and atherothrombosis.
- Demonstrating additional benefits of renin-angiotensin system blockers beyond blood pressure control is debated.
- Evidence for specific drug class advantages in moderate/high cardiovascular risk patients is often unclear.
- Renin-angiotensin system blockers have established indications in specific cardiovascular scenarios.
- Intermediate endpoints support a drug-based anti-hypertension strategy.
Conclusions:
- Renin-angiotensin system blockers are valuable tools in hypertension management, offering potential benefits beyond blood pressure control.
- Their favorable safety profile, especially for angiotensin II receptor blockers and renin inhibitors, supports early use in hypertensive patients.
- Analysis of intermediate endpoints reinforces the value of renin-angiotensin system blockers in a comprehensive anti-hypertension strategy.
Abstract:
Guidelines for the treatment of hypertension allow a wide range of choices to the physicians; however some differences are present about the preferred drugs to start treatment. The most important aim remains an adequate decrease of blood pressure, something not perfectly obtained in the general population, but some classes of anti-hypertensive drugs could show protective effects on cardiovascular events, which are independent from blood pressure levels (the so called effects beyond blood pressure control). In this context antagonists of the renin-angiotensin system may represent an important help for the physicians, keeping in mind the preclinical studies showing the central role of the renin-angiotensin system not only in the regulation of blood pressure but also in the atherothrombotic processes. The demonstration of an additional favourable effect of renin-angiotensin system blockers is not so obvious and frequently debated in the literature. Evidence-based medicine suggests that in patients at moderate/high cardiovascular risk it is difficult to have clear evidence of a specific advantage of some drug classes with respect to the others. However renin-angiotensin system blockers maintain compelling indications in particular cardiovascular situations; in addition analysis of intermediate end points, such as microalbuminuria, left ventricular hypertrophy, and arterial stiffness, gives further support to a drug-based anti-hypertension strategy. Last but not least, the optimal safety profile of these drugs, in particular of angiotensin II receptor blockers and renin inhibitors, allows their use in the very early stage of the hypertensive situation, as suggested by recent clinical trials.
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