Vnitr Lek 2013, 59(1):71-78

AII antagonists in the treatment of hypertension and prevention of CVA

J. Špinar^1,3,*, J. Vítovec^2,3

¹ Interní kardiologická klinika lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

² I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Lenka Špinarová, Ph.D, FESC

³ ICRC Brno, vedoucí programu doc. MUDr. Petr Němec, CSc., MBA

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 asso-ciated 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.

Keywords: AII antagonists; hypertension; cerebrovascular accidents; cognitive functions; eprosartan

Received: December 29, 2012; Accepted: January 2, 2013; Published: January 1, 2013  Show citation