Therapeutic potential of angiotensin II receptor antagonists

The circulating renin angiotensin system plays an important role in cardiov ascular homeostasis. More importantly, the local tissue renin angiotensin p lays a pivotal role in cell growth and remodelling of cardiomyocytes and on the peripheral arterial vasculature. in addition, the renin angiotensin sy stem is related to apoptosis, control of baroreflex and autonomic responses , vascular remodelling and regulation of coagulation, inflammation and oxid ation. The cardioprotective and vascular protective effects of the angioten sin receptive blockade appears to be related to selective blockade of the T ype I angiotensin II receptors. However, there is now growing evidence show ing that some of the effects of angiotensin II receptor blockers (ARBs) are related to the activation of the kinin pathways. This paper will review so me of the recent mechanisms related to the cardiovascular effects of angiot ensin and more specifically of ARBs. This paper will present the novel data on the role of ARB in the development of atherosclerosis, vascular remodel ling, coagulation balance and autonomic regulation. Finally, the role of AR Bs, used alone or in combination with ACE inhibitor in patients with heart failure, will be discussed.