Angiotensin receptor blockers: Current status and future prospects

Angiotensin receptor blockers (ARBs), through their physiological blockade of the renin-angiotensin system, reduce morbidity and mortality associated with hypertension, heart failure, myocardial infarction, stroke, diabetic nephropathy, and chronic kidney disease. Among many attributes, excellent tolerability, and their ability to control hypertension for 24 hours with a positive effect on renal function position them as a useful choice for hypertension and related conditions. Because of the widespread actions of the renin-angiotensin system on critical tissues, treatment with ARBs may be beneficial in special populations. Ongoing and future studies will be needed to conclusively determine if ARBs also improve outcomes in patients with heart failure and preserved systolic function, atrial fibrillation, cognitive dysfunction, and kidney transplant recipients. Preliminary clinical data also suggest that combining ARBs and angiotensin-converting enzyme inhibitors may provide a more optimal blockade of the renin-angiotensin system and, therefore, may offer greater cardio- and nephroprotection. Future data will help delineate which ARBs and angiotensin-converting enzyme inhibitors are best combined and which patient populations might benefit from the dual blockade of the renin-angiotensin system. (c) 2008 Elsevier Inc. All rights reserved.