Comparative assessment of angiotensin receptor blockers in different clinical settings
Paolo Verdecchia1, Fabio Angeli1, Salvatore Repaci1, Giovanni Mazzotta1, Giorgio Gentile2, Gianpaolo Reboldi2
1Struttura Complessa di Cardiologia, Unità di Ricerca Clinica ‘Cardiologia Preventiva’, Ospedale S. Maria della Misericordia, Perugia, Italy; 2Dipartimento di Medicina Interna, Università degli Studi di Perugia, Italy
Abstract: Cardiovascular and renal disease can be regarded as progressing along a sort of continuum which starts with cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, etc) evolves with progression of atherosclerotic lesions and organ damage, and then becomes clinically manifest with the major clinical syndromes (myocardial infarction, stroke, heart failure, end-stage renal disease). The blood pressure control remains a fundamental mechanism for prevention of cardiovascular disease. The renin–angiotensin system is believed to play an important role along different steps of the cardiovascular disease continuum. Convincing evidence accumulated over the last decade that therapeutic intervention with angiotensin receptor blockers (ARBs) is effective to slow down or block the progression of cardiovascular disease at different steps of the continuum, with measurable clinical benefits. However, despite the shared mechanism of action, each ARB is characterized by specific pharmacological properties that may influence its clinical efficacy. Indeed, important differences among available ARBs emerged from clinical studies. Therefore, generalization of results obtained with a specific ARB to all available ARBs may be misleading. The present review provides a comparative assessment of the different ARBs in their efficacy on major clinical end-points along the different steps of the cardiovascular disease continuum.
Keywords: hypertension, renin–angiotensin system, valsartan, telmisartan, irbesartan, losartan, olmesartan, eprosartan
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