Angiotensin receptor blockers (ARBs)
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Angiotensin Receptor Blockers (ARBs) in Hypertension Management
Angiotensin receptor blockers (ARBs) are widely recommended as first-line treatments for hypertension, alongside ACE inhibitors (ACEIs), calcium channel blockers, and thiazide diuretics. ARBs and ACEIs have similar effectiveness in lowering blood pressure, but ARBs are often preferred due to their better tolerability and fewer side effects, such as a lower risk of cough and angioedema. Additionally, ARBs have a neutral metabolic effect, making them suitable for patients with metabolic concerns 28.
Cardiovascular and Renal Protection with ARBs
ARBs provide significant protection against cardiovascular and renal damage in hypertensive patients. They help reduce the risk of heart failure, stroke, and the development of diabetes. However, while ARBs lower blood pressure and reduce the risk of some cardiovascular events, large-scale studies and meta-analyses have shown that they do not significantly reduce the risk of myocardial infarction, cardiovascular death, or all-cause mortality compared to placebo or other treatments 26. Some real-world data suggest that ARBs may be associated with lower all-cause mortality and reduced hospitalization for heart failure compared to ACEIs in certain populations, such as patients with acute myocardial infarction .
ARBs and Angiogenesis
The effects of ARBs on angiogenesis (the formation of new blood vessels) are complex and context-dependent. In cancer and some cardiovascular diseases, ARBs tend to have anti-angiogenic effects, potentially limiting tumor growth and abnormal vessel formation. However, in models of stroke and myocardial infarction, ARBs can promote beneficial angiogenesis, improving recovery by increasing vascular density .
Neuroprotective and Cognitive Effects of ARBs
Recent research highlights the neuroprotective properties of ARBs. They reduce inflammation and cell death in the brain, protect cerebral blood flow, and help maintain the blood-brain barrier. These effects have been observed in animal models of stroke, traumatic brain injury, Alzheimer's disease, and Parkinson's disease. Epidemiological studies suggest that ARBs may slow the progression of Alzheimer's disease and help preserve cognitive function after stroke and with aging 510.
ARBs in the Context of COVID-19
ARBs have been studied for their potential role in COVID-19 therapy. They may protect hypertensive patients with COVID-19 by reducing inflammation and supporting lung function. ARBs can enhance the protective effects of ACE2, a key enzyme involved in the entry of SARS-CoV-2 into cells. However, laboratory studies have shown that ARBs can increase ACE2 expression, which may lead to higher viral replication in certain cell types. This raises concerns about their use in COVID-19 patients, and careful evaluation is recommended 149.
Safety and Tolerability of ARBs
ARBs are generally well-tolerated, with a lower risk of side effects such as cough, angioedema, and certain metabolic disturbances compared to other antihypertensive agents. This favorable safety profile supports their use as a preferred option for many patients starting hypertension treatment 28.
Conclusion
ARBs are effective, well-tolerated antihypertensive agents with additional protective effects on the heart, kidneys, and brain. While they do not significantly reduce the risk of myocardial infarction or all-cause mortality compared to other treatments, their safety and potential benefits in specific populations make them a valuable option in clinical practice. Their role in COVID-19 and cognitive protection is promising but requires further research.
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