AII antagonists in the treatment of hypertension and prevention of CVA
Authors:
J. Špinar 1,3; J. Vítovec 2,3
Authors‘ workplace:
Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
1; I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Lenka Špinarová, Ph. D, FESC
2; ICRC Brno, vedoucí programu doc. MUDr. Petr Němec, CSc., MBA
3
Published in:
Vnitř Lék 2013; 59(1): 71-78
Category:
Review
Overview
AII antagonists (sartans) are considered to be a group of pharmaceuticals with comparable indications and comparable effects as ACE inhibitors, while almost lacking the side effect of a dry cough. Large clinical trials showed that AII antagonists had a comparable (statistically insignificantly smaller) effect on so called “hard targets”, i.e. mortality and morbidity, in patients with ischemic heart diseases and/or heart failure. The study of their effect in the treatment of hypertension was first limited to diabetics and patients with microalbuminuria and showed that they had a significant renoprotective effect in said cases. Large clinical trials followed, focusing on hypertension in primary as well as secondary prevention of cardiovascular diseases. Five large clinical trials focusing on AII antagonists addressed cerebrovascular accidents and cognitive functions: LIFE, SCOPE, OSCAR, MOSES and POWER. The LIFE study (Losartan Intervention For Endpoint) confirmed that in 9,193 patients with proven left ventricular hypertrophy, losartan led to a lower incidence of cerebrovascular accidents or new development of diabetes mellitus than atenolol, which in turn led to statistically significant lower primary endpoint (fatality, myocardial infarction and cerebrovascular accident) (p = 0.021), while blood pressure dropped at the same rate. The SCOPE study (Study on COgnition and Prognosis in Elderly hypertensives) compared candesartan with another antihypertensive treatment in 4,937 hypertonic patients older than 70. The primary endpoint was a decrease in massive cardiovascular accidents (fatality, MI, CVA). The decrease rate reached 10.9%, which was not considered statistically significant (p = 0.19). However, statistically significant was the decrease in cerebrovascular accidents (p = 0.04). The MOSES study (Morbidity and mortality after stroke) compared eprosartan and nitrendipine in secondary prevention of cerebrovascular diseases in 1,405 patients. Blood pressure was reduced to a comparable extent without showing significant differences between the two groups. During the study period, a total of 461 primary accidents occurred: 206 in patients with eprosartan and 255 in patients with nitrendipine (p = 0.014). Cardiovascular accidents were: 77 with eprosartan and 101 with nitrendipine (p = 0.06); cerebrovascular accidents were: 102 with eprosartan and 134 with nitrendipine (p = 0.03). OSCAR study was an open study with the objective to assess the impact of eprosartan treatment on cognitive functions. Use of eprosartan was associated with a significant reduction in blood pressure from 161.9/93.1 mm Hg to 136.1/80.8 mm Hg after 6 months (p < 0.0001). The total average score of the MMSE test after the completion of the follow-up period was 27.9 ± 2.9 compared to 27.1 ± 3.4 at the beginning (p < 0.0001). The results of the OSCAR study support the statement that antihypertensive treatment based on drugs that target the renin-angiotensin system is associated with the preservation of cognitive functions. The POWER study proved in a large unselected population the suitability and practical aspect of a reduction in the total cardiovascular risk by means of systematic treatment of high blood pressure.
Key words:
AII antagonists – hypertension – cerebrovascular accidents – cognitive functions – eprosartan
Sources
1. Dahlof B, Devereux RB, Kjeldsen SE for the LIFE investigators. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoints reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.
2. De Backer G. The SCORE model in the POWER study: an attempt to focus the limited resources for prevention on patients with greatest need. Curr Med Res Opin 2007; 23: (Suppl. 5): S19–S24.
3. Filipovský J, Widimský jr. J, Cífková R et al. Doporučení diagnostických a léčebných postupů arteriální hypertenze – verze 2012. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012; 58: 785–802.
4. Hanon O, Berrou JP, Negre-Pages L et al. Effects of hypertension therapy based on eprosartan on systolic arterial blood pressure and cognitive function: primary results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction open-label study. Journal of Hypertension 2008; 26: 1642–1650.
5. Hansson L, Lithell H, Skoog I v zastoupení řešitelů studie SCOPE. Study on cognition and prognosis in elderly hypertensives (SCOPE). Blood pressure 1999; 8: 177–183.
6. Hansson L, Lithell H, Skoog I v zastoupení řešitelů studie SCOPE. Study on cognition and prognosis in elderly hypertensives (SCOPE). Baseline characteristics. Blood pressure 2000; 9: 146–151.
7. Chalmes J, Mancia G, van Zwieten et al. 1999 World Health Organisation – International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17: 151–183.
8. Schrader J, Luders S, Kulschewski A et al. MOSES – Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention. Stroke 2005; 36: 1218–1226.
9. Špinar J, Vítovec J, Špinarová L. Eprosartan – duální blokátor AT1-receptorů. Kardiologická revue 2012; 14: 121–125.
10. Špinar J, Vítovec J, Špinarová L. Eprosartan: klinický profil. Hypertenze a kardiovaskulární prevence 2012; 1: 26–30.
11. Špinar J, Vítovec J. AII antagonisté vytáhli trumfové eso – studie LIFE a SCOPE. Cor Vasa 2002; 44: 537–541.
12. Špinar J, Vítovec J. AIIA v roce 2002. Blokátory receptoru 1 pro angiotenzin II v léčbě kardiovaskulárních onemocnění. Kardiologická revue 2002; 4: 215–224.
13. Task Force Members 2007. Guidelines for the management of arterial hypertension. J Hypertension 2007; 25: 1105–1187.
14. Widimský jr. J, Cífková R, Špinar J et al. Doporučení diagnostických a léčebných postupů arteriální hypertenze – verze 2007. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2008; 1: 101–118.
15. Xu FY, Yang B, Shi D et al. Antihypertensive effects and safety of eprosartan: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2012; 68: 195–205.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2013 Issue 1
Most read in this issue
- Drug induced osteoporosis
- Specificities of the diagnostics and therapy of exocrine pancreatic insufficiency
- Risk factors for relapsing and severe Clostridium difficile infection
- Outcomes of Catheter Ablation of Atrial Fibrillation in Patients over 65 Years of Age