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SMJ // Article
Review Article
The Pleiotropic Effects of Antihypertensive Agents: Do They Account for Additional Cardiovascular Benefit Beyond BP Reduction?
Abstract
Hypertension commonly clusters with other cardiovascular risk factors, giving rise to the concept that hypertension is a multifaceted disease that potentially shares common pathogenic pathways with other risk factors. The renin-angiotensin-aldosterone system has a central role in the shared mechanisms of hypertension and cardiovascular disease, primarily through angiotensin II. Increased levels of angiotensin II disrupt the balance of vasoactive substances and growth factors that regulate endothelial structure and function, and inhibition of the renin-angiotensin-aldosterone system with an angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker helps restore this equilibrium. Some pathogenic mechanisms may also be favorably affected by calcium channel blockade. While the relative contribution of pleiotropic effects to clinical benefit is difficult to quantify, based on recent data it is reasonable to consider using newer antihypertensive agents in selected high-risk patients to realize the benefits that may derive from interfering with pathogenic mechanisms of disease.
Key Points
* The renin-angiotensin-aldosterone system has a central role in the pathogenesis of cardiovascular disease.
* The deleterious effects of angiotensin II can be blocked by angiotensin-converting enzyme inhibitors and by angiotensin II receptor blockers.
* Agents that inhibit the renin-angiotensin-aldosterone system may exert beneficial effects in addition to blood pressure lowering.
* The relative contributions of pleiotropic effects versus the benefits of lowering blood pressure per se remain a subject of controversy.
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