Angiotensin II Receptor Antagonists

Abstract

Stroke is a devastating disease that heavily affects overall cardiovascular mortality and quality of life in surviving patients, and has a relevant burden on healthcare systems. Recent data derived both from large epidemiological surveys and from the analysis of events occurring in the clinical trials on hypertension, performed over the last 10 years, indicate that the incidence of stroke remains very high. These observations highlight the need for a more effective strategy to prevent stroke, especially in the hypertensive population. Hypertension is one of the major, modifiable cardiovascular risk factors contributing to stroke development, and therapeutic control of elevated blood pressure is associated with a relevant benefit in terms of reduced stroke incidence. On the other hand, even when sufficient control of hypertension is achieved, the risk of stroke remains significantly higher in hypertensive patients than that observed in normotensive patients. For these reasons, it is important to explore whether additional benefits in terms of stroke prevention can be obtained with specific treatment beyond blood pressure control. Head-to-head comparisons between older, traditional (diuretics and β-blockers) and newer (calcium channel antagonists, ACE inhibitors and angiotensin II receptor blockers) antihypertensive drugs provided evidence on stroke prevention across a number of large, randomised studies. This evidence convincingly supports the hypothesis that those agents blocking the renin-angiotensin system may confer protection towards stroke beyond its blood pressure-lowering properties, and indicates that this may be important to how hypertension is treated. In view of the persisting low perception of the impact of treatment on stroke, as well as of the insufficient control of blood pressure and stroke in many Western countries, these novel observations may generate remarkable educational and therapeutic outcomes.