Prevention of cardiovascular events and diabetes with angiotensin-receptor blockers in hypertension: Life, scope, and value

Abstract

Introduction Hypertension increases the risk for major cardiovascular events and progression of cardiovascular disease. Even modest reductions in blood pressure confer substantial reductions in risk for events. The renin-angiotensinaldosterone system (RAAS) and its principal mediator, angiotensin II, have pivotal roles in the shortand longterm regulation of blood pressure and in the prognosis of hypertension. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARB), which interfere with the vasoconstrictive and trophic effects of angiotensin II, have blood pressure-lowering effects similar to other antihypertensive agents but also have vasculoprotective properties and preserve renal function in patients with nephropathy due to diabetes and from other causes. Three trials have evaluated the effects of ARB treatment in patients with hypertension and manifestations of cardiovascular disease and/or diabetes. These trials focused on various patient populations based on age and cardiovascular risk level, used different comparator agents (eg, placebo, β-blocker, calcium antagonist), and had different primary end points.