Nuove indicazioni sull'impiego degli antagonisti recettoriali dell'angiotensina II: Il peso delle evidenze

The renin-angiotensin system (RAS) is involved in a number of pathophysiological mechanisms leading to major cardiovascular events, such as myocardial infarction and ischemic stroke. Since angiotensin II is the biological effector of this system, and it is responsible for most of these actions of RAS through its binding with the AT1 subtype receptors, pharmacologic antagonism of Angiotensin II actually represents an effective therapeutic approach for management of cardiovascular diseases. Therefore, angiotensin II receptor blockers (ARBs) appear like rational and suitable pharmacological tools to antagonize the unfavourable effects of RAS. ARBs are currently tested in large, international multicenter studies in high-risk patients, in patients with metabolic syndrome, in patients with microalbuminuria, or even to prevent microalbuminuria and also in patients with preserved left ventricular function. Together with the indication of prevention of stroke in hypertensive patients with left ventricular hypertrophy, yet approved for losartan, these potential new areas of intervention for RAS could significantly modify the future therapeutic strategies, to obtain a more effective prevention and more comprehensive treatment of cardiovascular diseases and to reduce cardiovascular mortality and morbidity.