Angiotensin II-Receptor Blockers: their Relevance in Clinical Practice

Abstract

The implication of the renin angiotensin system (RAS) and specifically angiotensin II in the pathogenesis of essential hypertension, cardiac, cerebrovascular and renal disease is well established. Among the different categories of drugs that manage hypertension, angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are notably effective in the downregulation of RAS. Whereas ACEIs achieve RAS inhibition by constraining the conversion of angiotensin I to angiotensin II, they can display adverse effects, such as cough and angioedema that result from the increased production of bradykinin and prostaglandin. The direct antagonistic action of ARBs on angiotensin II receptors has proved to be very well tolerated. Achieving rapid blood pressure reduction and twenty-four hour hypertension control, they are superior to other antihypertensive agents in the regression of left ventricular hypertrophy, new onset diabetes and stroke and in the delay of renal dysfunction. The combination of ARBs with other drug categories, such as diuretics or calcium channel blockers, can provide additive effects, favouring their recommendation and use for the clinical management of hypertension and cardiovascular diseases. Meta-analyses of clinical trials have provided evidence that ARBs are comparable with other drugs against cardiovascular and all-cause mortality.