Document Detail

Is the angiotensin II Type 2 receptor cerebroprotective?
MedLine Citation:
PMID:  15128469     Owner:  NLM     Status:  MEDLINE    
Most of the deleterious effects of angiotensin II (Ang II) on blood pressure (BP), cardiovascular remodeling, and atherosclerosis are mediated by Ang II type 1 (AT1)-receptor activation. This explains why Ang-II-decreasing or blocking drugs have been successful in decreasing global cardiovascular morbimortality in patients with cardiac complications. However, in primary or secondary stroke prevention trials in patients with low cardiac risk, b-blockers and angiotensin-converting enzyme inhibitors (ACEIs), which decrease Ang II formation, seem to be less protective than thiazides and dihydropyridines, which increase Ang II. When compared with a beta-blocker, an Ang II-increasing AT1-receptor blocker better protects against stroke but not against cardiac events, whereas an ACEI gives the same protection against both cardiac and cerebral events. This dissociation between blood-pressure-independent cardiac and cerebral protection between b-blockers or ACEIs versus AT1-blockers in patients with low cardiac risk can be best explained if, besides the beneficial vascular effect of AT1-receptor blunting, there is evidence of a beneficial effect of non-AT1-receptor activation. In this review, we present experimental evidence for AT2- and AT4-receptor-mediated brain-anti-ischemic mechanisms and propose a direct comparison of AT1-blockers with ACEIs to prove the clinical effectiveness of non-AT1-mediated mechanisms in stroke prevention, particularly in patients with a higher risk for stroke than for cardiac complications.
Albert Fournier; Jean Michel Achard; Florent Boutitie; Hakim Mazouz; Janette Mansour; Roxana Oprisiu; Leonardo Fernandez; Franz Messerli
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current hypertension reports     Volume:  6     ISSN:  1522-6417     ISO Abbreviation:  Curr. Hypertens. Rep.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-06     Completed Date:  2004-09-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100888982     Medline TA:  Curr Hypertens Rep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  182-9     Citation Subset:  IM    
Service de Néphrologie, CHU SUD, Avenue René Laënnec, 80054 Amiens 1, France.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Blood Pressure / drug effects
Brain / drug effects,  pathology,  physiopathology
Brain Ischemia / physiopathology,  prevention & control*
Receptor, Angiotensin, Type 1 / therapeutic use
Receptor, Angiotensin, Type 2 / therapeutic use*
Receptors, Angiotensin / therapeutic use
Stroke / physiopathology,  prevention & control
Reg. No./Substance:
0/AT4 receptor; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Receptor, Angiotensin, Type 1; 0/Receptor, Angiotensin, Type 2; 0/Receptors, Angiotensin

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