Preventing the cardiovascular complications of hypertension

Abstract

AT 1-receptor blockers reduce blood pressure and also show other beneficial effects on target organs. Meta-analyses and studies such as the CATCH Study with candesartan show that AT1-receptor blockers are as effective as, or more effective than, other antihypertensive agents in reversing left-ventricular hypertrophy, while nephroprotective effects have been demonstrated in a number of clinical endpoint studies. Similarly, neuroprotective effects have been shown in laboratory and clinical studies, including the ACCESS Study with candesartan. The LIFE Study with losartan and the SCOPE Study with candesartan have investigated the impact of AT 1-receptor blockade on cardiovascular complications in hypertension. LIFE showed that AT1-receptor blockade significantly reduced the risk of cardiovascular death, stroke or myocardial infarction, compared with b-blockers, while SCOPE showed a significant reduction in non-fatal stroke in candesartan-treated patients, compared with control treatment. An analysis in patients from SCOPE who did not receive open-label, add-on antihypertensive therapy after randomization showed a significant 32% reduction in major cardiovascular events with candesartan. The recently reported VALUE study found no difference in overall cardiac disease between valsartan- based and amlodipine-based therapy, but demonstrated the importance of blood- pressure control in high-risk individuals, with some cause-specific endpoints favouring amlodipine-based therapy. New-onset diabetes was less frequent with AT1-receptor blockade than control therapy in all of the three major intervention trials with AT 1-receptor blockers in hypertension.