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Angiotensin II receptor blockers and cardiovascular outcomes: the evidence now and in the future

SUNY Downstate College of Medicine, Brooklyn, New York, USA, minskyja{at}cs.com

The blood-pressure-lowering efficacy of both angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) has been clearly demonstrated in recent years, although there is evidence that within the ARB class the individual therapies are not necessarily identical in terms of sustained and consistent antihypertensive efficacy over the entire dosing period. However, the results of the recent HOPE study have demonstrated that ACE-I have a wider role to play in treating cardiovascular disease, and support the idea that ACE inhibition specifically has a vascular protective effect. The most dramatic benefits were seen in patients with systolic blood pressures in the hypertensive range. The ability of the ACE-I to provide protective effects beyond blood pressure control may be due to their ability to attenuate the breakdown of kinins as well as a role in reducing angiotensin II. These data pose the question as to whether the pharmacological properties of the ARBs, in addition to their antihypertensive efficacy, may also play a significant role in influencing cardiovascular outcomes. A number of prospective long-term studies, including VALUE, SCOPE, LIFE, VALIANT, OPTIMAAL, VAL-HEFT and CHARM I-III, are investigating the effects of the ARBs of mortality and morbidity in patients with cardiovascular disease. These studies should answer important questions with respect to the role that ARBs may have in influencing cardiovascular outcomes, although it remains to be seen whether ARBs can match the protective effects of ramipril in high-risk patients. Given the excellent tolerability of the ARBs, it will be of value to examine the influence of ARBs on cardiovascular outcomes in all relevant patient groups.

Key Words: angiotensin II receptor blockers • angiotensin-converting enzyme inhibitors • clinical trials • renin-angiotensin system

References

• Pitt B., Segal R., Martinez FA et al. Randomized trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE). Lancet 1997;349:747-52.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pitt B., Poole-Wilson PA, Segal R. et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial - the Losartan Heart Failure Survival Study ELITE II. Lancet 2000;355:1582-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hollenberg NK, Sever PS The past, present and future of hypertension management: a potential role for AT1-receptor antagonists. JRAAS 2000;1:5-10.[Medline] [Order article via Infotrieve]
• McKelvie RS,Yusuf S., Pericak D. et al. Comparison of candesartan, enalapril, and their combination in congestive heart failure: Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) Pilot Study. Circulation 1999; 100:1056-64.[Abstract/Free Full Text]
• Cohn JN,Tognoni G., Glazer RD et al. Rationale and design of the Valsartan Heart Failure Trial: a large multinational trial to assess the effects of valsartan, an angiotensin-receptor blocker, on morbidity and mortality in chronic congestive heart failure. J Card Fail 1999;5:155-60.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Rodby RA, Rohde RD, Clarke WR et al.The Irbesartan type II Diabetic NephropathyTrial: study design and baseline patient characteristics. For the Collaborative Study Group. Nephrol Dial Transplant 2000;15:487-97.[Abstract/Free Full Text]
• Dickstein K., Kjekshus J. Comparison of the effects of losartan and captopril on mortality in patients after acute myocardial infarction: the OPTIMAAL trial design. Optimal Therapy in Myocardial Infarction with the Angiotensin II Antagonist Losartan. Am J Cardiol 1999;83:477-81.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dahlof B., Devereux R., de Faire U. et al. The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study: rationale, design, and methods. The LIFE Study Group. Am J Hypertens 1997;10:705-13.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Swedberg K., Pfeffer M., Granger C. et al. Candesartan in heart failure - assessment of reduction in mortality and morbidity (CHARM): rationale and design. Charm-Programme Investigators.J Card Fail 1999;5:276-82.[CrossRef][Medline] [Order article via Infotrieve]
• Hansson L., Lithell H., Skoog I. et al. Study on COgnition and Prognosis in the Elderly (SCOPE). Blood Pressure 1999;8:177-83.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pfeffer MA, McMurray J., Leizorovicz A. et al. Valsartan in acute myocardial infarction trial (VALIANT): rationale and design. Am Heart J 2000;140:727-50.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Mann J., Julius S. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial of cardiovascular events in hypertension. Rationale and design. Blood Pressure 1998;7:176-83.[CrossRef][Medline] [Order article via Infotrieve]
• ABCD-2V is based on the ABCD trial. See Estacio RO, Schrier RW Antihypertensive therapy in type 2 diabetes: implications of the appropriate blood pressure control in diabetes (ABCD) trial. Am J Cardiol 1998;82:9R-14R.[Web of Science][Medline] [Order article via Infotrieve]
• Pfeffer MA, Braunwald E., Moyé LA et al., on behalf of the SAVE Investigators. Results of the Survival and Ventricular Enlargement Trial: effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.NEnglJMed 1992;327:669-77.[Abstract]
• Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl JMed 2000;342:145-53.[Abstract/Free Full Text]
• Agarwal R. Add-on angiotensin receptor blockade with maximized ACE inhibition. Kidney Int 2001;59:2282-9.[Web of Science][Medline] [Order article via Infotrieve]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 2, No. 2 suppl, S12-S16 (2001)
DOI: 10.3317/jraas.2001.029


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Weber, M. Search for Related Content PubMed PubMed Citation Articles by Weber, M. Social Bookmarking                         What's this?