Mechanisms for the clinical benefits of angiotensin II receptor blockers

The renin-angiotensin-aldosterone system (RAAS) regulates sodium balance, fluid volume, and blood pressure (BP). It is also implicated in the progression of heart failure, hypertension, and kidney disease; this is mediated by the binding of angiotensin II (ang II) to the ang II type 1 but not the ang II type 2 receptor. Preclinical and clinical studies have shown that blockade of the RAAS with ang II receptor blockers (ARB) is effective not only in controlling BP but also in preventing end-organ damage. Through their mechanism of action, ARB may offer benefit with respect to endothelial dysfunction and vascular remodeling, as well as cardiac and renal protection. In addition, both recent and ongoing clinical trials help to clarify further the mechanisms for the benefits of using ARB across the cardiovascular continuum. (c) 2005 American Journal of Hypertension, Ltd.