Review Article

Angiotensin Receptor Blockers for Management of Hypertension

Authors: Daniel F. Catanzaro, PhD, MBA, William H. Frishman, MD

Abstract

The renin-angiotensin-aldosterone system (RAAS) plays a major role in blood pressure regulation and is thus an important therapeutic target in the management of hypertension. Angiotensin receptor blockers (ARBs), which interrupt RAAS overactivity by blocking a specific receptor that mediates the pathogenic activity of angiotensin II, represent a major addition to the clinician's armamentarium for the management of hypertension. A solid body of clinical evidence demonstrates that ARBs are effective in the management of hypertension as monotherapy or in combination with other agents. Although comparable to angiotensin-converting enzyme inhibitors and other major classes of antihypertensive agents in the treatment of hypertension, the favorable tolerability profile of ARBs make them an attractive alternative for many patients. Recent evidence suggests that treatment persistence with ARB therapy during a 12-month period is typically higher than with other antihypertensive classes, a finding perhaps driven by fewer treatment-limiting side effects. The combination of clinical efficacy and tolerability should render ARBs as a major treatment alternative for hypertension.


Key Points


* The renin-angiotensin-aldosterone system (RAAS) is a major modulator of blood pressure (BP) and an important therapeutic target in hypertension.


* Both angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are effective antihypertensive agents in a variety of clinical settings.


* Although the combination of an ACEI or direct renin inhibitor and ARBs have theoretical benefits for treatment of hypertension over and above that of either agent alone, clinical trials to date have not clearly substantiated this approach.

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