Document Detail


Targeting cardiovascular protection: the concept of dual renin-angiotensin system control.
MedLine Citation:
PMID:  18449381     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The renin-angiotensin system plays a key role in the regulation of blood pressure, and blockade of this system now forms a central part of strategies to reduce the risk for cardiovascular events in high-risk patients. Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to be effective in lowering blood pressure and reducing the risk for cardiovascular events, but both classes of drug have some limitations. Plasma concentrations of angiotensin II increase during ACE-inhibitor therapy in some patients, partly as a result of the production of angiotensin II via non-ACE pathways; furthermore, elevated aldosterone concentrations can occur in a significant proportion of patients. ARBs block the deleterious effects of angiotensin II at angiotensin type 1 receptors irrespective of the origin of the peptide, but the beneficial effects of kinins may be diminished. ARB therapy results in activation of angiotensin type 2 receptors, resulting in potentially beneficial anti-inflammatory, antithrombotic, and antiproliferative effects, but the clinical significance of these effects remains controversial. Some ARBs, particularly telmisartan, have been shown to act as partial agonists of peroxisome proliferator-activated receptor gamma, thereby increasing insulin sensitivity. Combination therapy with ACE inhibitors and ARBs offers the potential for effective blood pressure control, decreased aldosterone production, enhanced kinin activity, and increased insulin sensitivity. The potential clinical benefits of this approach in high-risk patients are currently being investigated in the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), which is comparing therapy using a combination of telmisartan plus ramipril with the use of each drug in monotherapy.
Authors:
Thomas Unger; Anne Jakobsen; Jose Heroys; Ann Ralph; Tomas Rees; Michael Shaw
Publication Detail:
Type:  Journal Article; Review     Date:  2008-03-26
Journal Detail:
Title:  Medscape journal of medicine     Volume:  10 Suppl     ISSN:  1934-1997     ISO Abbreviation:  Medscape J Med     Publication Date:  2008  
Date Detail:
Created Date:  2008-05-01     Completed Date:  2008-06-05     Revised Date:  2013-06-05    
Medline Journal Info:
Nlm Unique ID:  101462763     Medline TA:  Medscape J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S4     Citation Subset:  IM    
Affiliation:
Centre for Cardiovascular Research (CCR)/Institute of Pharmacology, Charité-Universitätsmedizin, Berlin, Germany. thomas.unger@charite.de
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MeSH Terms
Descriptor/Qualifier:
Angiotensin II Type 1 Receptor Blockers / administration & dosage*
Angiotensin-Converting Enzyme Inhibitors / administration & dosage*
Cardiotonic Agents / administration & dosage*
Cardiovascular Diseases / physiopathology*,  prevention & control*
Drug Delivery Systems / methods*
Humans
Renin-Angiotensin System / drug effects*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Cardiotonic Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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