Farsang Csaba
Cardiometabolic Center, Department of Internal Medicine, St Imre Hospital, Budapest, Hungary.
Vasc Health Risk Manag. 2011;7:605-22. doi: 10.2147/VHRM.S23468. Epub 2011 Sep 26.
The worldwide burden of cardiovascular disease is growing. In addition to lifestyle changes, pharmacologic agents that can modify cardiovascular disease processes have the potential to reduce cardiovascular events. Antihypertensive agents are widely used to reduce the risk of cardiovascular events partly beyond that of blood pressure-lowering. In particular, the angiotensin II receptor blockers (ARBs), which antagonize the vasoconstrictive and proinflammatory/pro-proliferative effects of angiotensin II, have been shown to be cardio vascularly protective and well tolerated. Although the eight currently available ARBs are all indicated for the treatment of hypertension, they have partly different pharmacology, and their pharmacokinetic and pharmacodynamic properties differ. ARB trials for reduction of cardiovascular risk can be broadly categorized into those in patients with/without hypertension and additional risk factors, in patients with evidence of cardiovascular disease, and in patients with severe cardiovascular disease, such as heart failure. These differences have led to their indications in different populations. For hypertensive patients with left ventricular hypertrophy, losartan was approved to have an indication for stroke prevention, while for most patients at high-risk for cardiovascular events, telmisartan is an appropriate therapy because it has a cardiovascular preventive indication. Other ARBs are indicated for narrowly defined high-risk patients, such as those with hypertension or heart failure. Although in one analysis a possible link between ARBs and increased risks of cancer has surfaced, several meta-analyses, using the most comprehensive data available, have found no link between any ARB, or the class as a whole, and cancer. Most recently, the US Food and Drug Administration completed a review of the potential risk of cancer and concluded that treatment with an ARB medication does not increase the risk of developing cancer. This review discusses the clinical evidence supporting the different indications for each of the ARBs and the outstanding safety of this drug class.
心血管疾病的全球负担正在增加。除了生活方式的改变外，能够改变心血管疾病进程的药物有可能减少心血管事件。抗高血压药物被广泛用于降低心血管事件风险，部分原因在于其作用超出了单纯降低血压的范畴。特别是血管紧张素II受体阻滞剂（ARB），它能拮抗血管紧张素II的血管收缩和促炎/促增殖作用，已被证明具有心血管保护作用且耐受性良好。尽管目前可用的八种ARB均被用于治疗高血压，但其药理学部分存在差异，药代动力学和药效学特性也有所不同。降低心血管风险的ARB试验大致可分为针对有/无高血压及其他危险因素的患者、有心血管疾病证据的患者以及患有严重心血管疾病（如心力衰竭）的患者的试验。这些差异导致了它们在不同人群中的适应证。对于患有左心室肥厚的高血压患者，氯沙坦被批准用于预防中风，而对于大多数心血管事件高危患者，替米沙坦是一种合适的治疗药物，因为它具有心血管预防适应证。其他ARB则适用于定义较窄的高危患者，如高血压或心力衰竭患者。尽管在一项分析中发现ARB与癌症风险增加之间可能存在联系，但几项使用现有最全面数据的荟萃分析发现，任何一种ARB或整个ARB类别与癌症之间均无关联。最近，美国食品药品监督管理局完成了对癌症潜在风险的审查，并得出结论：使用ARB药物治疗不会增加患癌风险。本综述讨论了支持每种ARB不同适应证的临床证据以及该药物类别的卓越安全性。
