Angiotensin Receptor Blockers and Cardiovascular Protection: Are We ONTARGET?

      It is well known that activation of the renin-angiotensin system (RAS) plays a crucial role in the initiation and progression of cardiovascular disease (CVD) and target organ damage in patients with hypertension. There is growing recognition that RAS inhibition provides protection against cardiovascular damage, irrespective of blood pressure (BP) levels. Angiotensin-converting enzyme (ACE) inhibitors have been shown to prevent cardiovascular, neurologic, and renal complications in high-risk patients. With the realization that ACE inhibitors do not provide optimal blockade of the RAS, angiotensin receptor blockers (ARBs) have been developed. Although the efficacy of ARBs in the treatment of hypertension is comparable with that of ACE inhibitors, the former class of drugs has not yielded consistent or superior effects on target organ protection. Therefore, an unsettled issue in preventive medicine has been whether ARBs are as effective as (or superior to) ACE inhibitors in high-risk populations.
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