심혈관 질환에서 안지오텐신 II 수용체 차단제의 최근 논점들
Current Issues on the Angiotensin II Receptor Blocker in Cardiovascular Disease
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To reduce cardio-cerebro-vascular and renal morbidity and mortality, the current guidelines on the treatment of hypertension recommend evaluating and managing total cardiovascular risks of the patient with hypertension, not just focused on reducing blood pressure itself. In this point of view, the angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are considered to be ideal drugs in the treatment of hypertension, because the angiotensin II plays a pivotal role in every stage of cardiovascular disease continuum. Many studies have shown that the ARBs were not only effective in lowering blood pressure, but also had another role in reducing morbidity and mortality of heart failure, myocardial infarction, stroke, diabetic nephropathy, chronic kidney disease, and the recurrence of atrial fibrillation, so called beyond blood pressure lowering effects or pleiotropic effects. However, these favorable effects of ARBs are counter-balanced by some debating issues, myocardial infarction paradox or cancer risk. Furthermore, the issue whether ARBs could replace the role of ACEIs in the treatment of cardiovascular diseases is not resolved yet. Because there have been no randomized studies proving the ARBs are better than ACEIs in terms of cardiovascular morbidity or mortality, the current status of the role of ARBs are an reasonable alternative of ACEIs. In this review, the current issues and status of ARBs will be discussed.
Abstract
To reduce cardio-cerebro-vascular and renal morbidity and mortality, the current guidelines on the treatment of hypertension recommend evaluating and managing total cardiovascular risks of the patient with hypertension, not just focused on reducing blood pressure itself. In this point of view, the angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are considered to be ideal drugs in the treatment of hypertension, because the angiotensin II plays a pivotal role in every stage of cardiovascular disease continuum. Many studies have shown that the ARBs were not only effective in lowering blood pressure, but also had another role in reducing morbidity and mortality of heart failure, myocardial infarction, stroke, diabetic nephropathy, chronic kidney disease, and the recurrence of atrial fibrillation, so called beyond blood pressure lowering effects or pleiotropic effects. However, these favorable effects of ARBs are counter-balanced by some debating issues, myocardial infarction paradox or cancer risk. Furthermore, the issue whether ARBs could replace the role of ACEIs in the treatment of cardiovascular diseases is not resolved yet. Because there have been no randomized studies proving the ARBs are better than ACEIs in terms of cardiovascular morbidity or mortality, the current status of the role of ARBs are an reasonable alternative of ACEIs. In this review, the current issues and status of ARBs will be discussed.
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