Angiotensin II receptor antagonists are effective and well-tolerated for reducing blood pressure, with emerging utility in heart failure and renal failure for patients intolerant to ACE inhibitors.
What is the efficacy and safety profile of angiotensin II receptor antagonists in cardiovascular and renal conditions compared to ACE inhibitors?
AIIRAs represent an important, well-tolerated alternative to ACE inhibitors for managing hypertension, heart failure, and diabetic nephropathy.
Inhibiting the renin-angiotensin-aldosterone system through the use of angiotensin-converting enzyme (ACE) inhibitors has proven very useful in the treatment of hypertension, congestive heart failure (CHF) and progressive renal failure. More recently, agents that directly block the angiotensin II Type 1 (AT(1)) receptor--angiotensin II receptor antagonists (AIIRAs)--have been developed. These agents are thought to have a more specific mechanism of action since they do not affect other hormone systems as do the ACE inhibitors. Whether such specificity results in a different efficacy profile is still being determined. However, these drugs are extremely well-tolerated and very safe. AIIRAs are effective in the reduction of both systolic and diastolic blood pressure and compare favourably to other classes of agents. Recent results indicate that at least one AIIRA has a favourable effect on stroke in hypertensive patients with left ventricular hypertrophy. Additional studies with other members of the class will provide further information on similar outcomes. In CHF patients, ACE inhibitors remain the drug of choice and AIIRAs are best utilised in patients who cannot tolerate an ACE inhibitor or in those receiving an ACE inhibitor who cannot tolerate a beta-blocker and need additional therapy. AIIRAs are effective in slowing the progression of renal failure in patients with Type II diabetes and may be effective in other proteinuric conditions. Whether they are more or less effective than ACE inhibitors is unknown. Overall, AIIRAs represent an important addition to the armamentarium of cardiovascular therapies with an excellent safety record and an emerging profile of utility in multiple cardiovascular conditions.
Neil H. Shusterman (Mon,) conducted a review in Hypertension, congestive heart failure, and progressive renal failure. Angiotensin II receptor antagonists vs. ACE inhibitors was evaluated. Angiotensin II receptor antagonists are effective and well-tolerated for reducing blood pressure, with emerging utility in heart failure and renal failure for patients intolerant to ACE inhibitors.