Tag Archives: angiotensin-receptor blocker

Introduction Therapeutic interventions in chronic heart failure (CHF) can lead to renal dysfunction. Combination of the aldosterone antagonist (AA) spironolactone with either angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), reduced mortality and hospitalisation rates and improved the New York Heart Association (NYHA) functional class in patients recruited into the Randomised Aldactone Evaluation Study (RALES).1 That study showed no statistically significant difference in the incidence of hyperkalaemia between those on AA and those on placebo.1 However, when the results of the trial were implemented int

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Impact of hypertension Epidemiological data have established a strong direct relationship between increased BP and raised cardiovascular (CV) disease risk. For individuals aged 40–69 years, each increment in systolic BP of 20 mmHg or diastolic BP of 10 mmHg doubles the risk of CV disease (i.e. stroke, ischaemic heart disease, and other vascular diseases) across the entire BP range.3 Figure 1. Prevalence of hypertension worldwide The World Health Organization has identified high BP as one of the most important preventable causes of premature morbidity and mortality. Antihypertensive drugs have convincingly been shown to be effective treatmen

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Renal disease and diabetes Microalbuminuria is known to be a marker of increased cardiovascular (CV) risk. It is not clear whether reducing microalbuminuria on its own is associated with an improved cardiovascular prognosis, but in secondary analyses from studies of angiotensin receptor blockers (ARBs) in people with type 2 diabetes, reduction in albuminuria was associated with a decreased risk of a CV event. Observational analyses from the RENAAL trial found that the magnitude of albuminuria reduction predicted the reduced risk of CV events (figure 1).1 Figure 1. Kaplan-Meier curves for cardiovascular (CV) and heart failure end points, strat

This brief paper considers how such cost pressures may affect the use of angiotensin receptor blockers (ARBs) in the NHS, given that although losartan is the first drug in this class to become generic in March 2010, others will quickly follow suit. Valsartan loses patent protection in 2011, with candesartan and irbesartan following in 2012. Indications for ARB use Recent data indicate that candesartan is presently the most widely used ARB in England, accounting for almost a third of all ARB prescriptions. This is in part because it has been competitively priced compared with other ARBs. In average prescription cost terms, candesartan has in r

Introduction Drugs that block the renin–angiotensin–aldosterone system, the angiotensin-converting enzyme inhibitors (ACEIs) and the angiotensin-receptor blockers (ARBs), have been shown to be effective in the management of hypertension, heart failure and several forms of renal disease including diabetic nephropathy. For this reason, the use of these agents is likely to increase steadily in the coming years. It is also clear from many of the randomised controlled trials that there is a dose-response curve for these agents, with higher doses being more effective.1-6 In the course of our clinical practice in acute general medicine, we obser