Angiotensin II receptor blockers in the treatment of the cardiovascular disease continuum

Abstract

Background: The cardiovascular disease (CVD) continuum is a chain of events that begins with a host of risk factors, including dyslipidemia, hypertension, diabetes, visceral obesity, and smoking. If left untreated, it might progress to atherosclerosis, left ventricular hypertrophy, coronary artery disease, myocardial infarction, left ventricular remodeling, left ventricular enlargement, and eventually endstage heart disease and death. Initiation of treatment, at any stage in its course, might prevent or delay its further progression. Objective: This review discusses data from doubleblind, randomized controlled trials (RCTs) that have investigated the effects of angiotensin II receptor blockers (ARBs) on various stages of the CVD continuum. Methods: PubMed/MEDLINE was searched for relevant English-language double-blind RCTs using the years 1995 to 2008 and the terms angiotensin type II receptor blocker, renin-angiotensin system, hypertension, heart failure, left ventricular hypertropby, renal disease, stroke, and cerebrovascular disease. Results: A total of 13 studies were included in this review. The results suggest that ARB-based therapy has cardioprotective, cerebroprotective, and renoprotective effects, including regression of left ventricular hypertrophy, reduction in the risk of stroke, and slowing of the progression of renal disease. Conclusions: Treatment of CVD risk factors, including hypertension, is increasingly recognized as a way to interrupt the CVD continuum. Activation of the renin-angiotensin system (RAS) contributes to the development and progression of CVD, and RAS blockade has been reported to be beneficial at all stages of the CVD continuum.