Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in atherosclerosis |
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Authors: | Eva Lonn |
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Institution: | (1) Division of Cardiology and Population Health Institute, McMaster University, Hamilton General Hospital, 237 Barton Street East, L8L 2X2 Hamilton, ON, Canada |
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Abstract: | Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) effectively interfere with the renin-angiotensin
system and exert various beneficial actions on cardiac and vascular structure and function, beyond their blood pressure-lowering
effects. Randomized, controlled clinical trials have shown that ACE inhibitors improve endothelial function, cardiac and vascular
remodeling, retard the anatomic progression of atherosclerosis, and reduce the risk of myocardial infarction, stroke, and
cardiovascular death. Therefore, these agents are recommended in the treatment of a wide range of patients at risk for adverse
cardiovascular outcomes, including those with coronary disease, prior stroke, peripheral arterial disease, high-risk diabetes,
hypertension, and heart failure. ARBs are effective blood pressure-lowering and renoprotective agents and can be used in heart
failure in patients who do not tolerate ACE inhibitors. The role of ARBs in the prevention of atherosclerosis and its sequelae
is currently under investigation. The use of combined ACE inhibitor plus ARB therapy offers theoretical advantages over the
use of each of these agents alone and is also under investigation in large, randomized clinical trials. |
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