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Risk reduction by preventing stroke: need for blockade of angiotensin II and catecholamines?
Curr Med Res Opin. 2007 Nov; 23 Suppl 5:S25-9.CM

Abstract

Angiotensin (AT) II and noradrenaline play major roles in hypertension, stroke and coronary heart disease, which are themselves interlinked. Harmful effects of AT II are not blocked solely by angiotensin-converting enzyme inhibitors, as it is now evident that AT II is generated by other enzymes such as chymase. Angiotensin II also stimulates noradrenaline release modulated by presynaptic receptors on sympathetic nerves. Numerous studies have defined the action of the AT II type 1 receptor blocker (ARB) eprosartan as controlling noradrenergic and adrenergic effects, resulting from actions on the renin-angiotensin-aldosterone system and the sympathetic nervous system. Clinical studies have been carried out to assess the effects of ARBs on morbidity and mortality. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial compared the effects of valsartan and the calcium channel blocker (CCB) amlodipine in over 15,000 patients at high risk of a cardiac event. Results showed that blood pressure was reduced by both treatments and cardiac mortality/morbidity was similar in both groups. By contrast, the Morbidity and mortality after Stroke, Eprosartan compared with nitrendipine for Secondary prevention (MOSES) study (n = 1405) generated results which differed from the VALUE study, in that blood pressure was reduced by both eprosartan and nitrendipine, but eprosartan reduced all cardiovascular and cerebrovascular events to a greater extent than nitrendipine. It is also possible that any delayed clinical benefit of eprosartan could be due to reverse cardiac remodelling. Eprosartan, by blocking AT II receptors, reducing noradrenaline release and blocking catecholamine actions, may, therefore, provide greater protection against vascular events than CCBs or other ARBs.

Authors+Show Affiliations

Heart Center, Department of Internal Medicine and Cardiology, Philipps University of Marburg, Germany. rupp@staff.uni-marburg.de

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18093411

Citation

Rupp, Heinz. "Risk Reduction By Preventing Stroke: Need for Blockade of Angiotensin II and Catecholamines?" Current Medical Research and Opinion, vol. 23 Suppl 5, 2007, pp. S25-9.
Rupp H. Risk reduction by preventing stroke: need for blockade of angiotensin II and catecholamines? Curr Med Res Opin. 2007;23 Suppl 5:S25-9.
Rupp, H. (2007). Risk reduction by preventing stroke: need for blockade of angiotensin II and catecholamines? Current Medical Research and Opinion, 23 Suppl 5, S25-9. https://doi.org/10.1185/030079907X260737
Rupp H. Risk Reduction By Preventing Stroke: Need for Blockade of Angiotensin II and Catecholamines. Curr Med Res Opin. 2007;23 Suppl 5:S25-9. PubMed PMID: 18093411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk reduction by preventing stroke: need for blockade of angiotensin II and catecholamines? A1 - Rupp,Heinz, PY - 2008/1/10/pubmed PY - 2008/1/26/medline PY - 2008/1/10/entrez SP - S25 EP - 9 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 Suppl 5 N2 - Angiotensin (AT) II and noradrenaline play major roles in hypertension, stroke and coronary heart disease, which are themselves interlinked. Harmful effects of AT II are not blocked solely by angiotensin-converting enzyme inhibitors, as it is now evident that AT II is generated by other enzymes such as chymase. Angiotensin II also stimulates noradrenaline release modulated by presynaptic receptors on sympathetic nerves. Numerous studies have defined the action of the AT II type 1 receptor blocker (ARB) eprosartan as controlling noradrenergic and adrenergic effects, resulting from actions on the renin-angiotensin-aldosterone system and the sympathetic nervous system. Clinical studies have been carried out to assess the effects of ARBs on morbidity and mortality. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial compared the effects of valsartan and the calcium channel blocker (CCB) amlodipine in over 15,000 patients at high risk of a cardiac event. Results showed that blood pressure was reduced by both treatments and cardiac mortality/morbidity was similar in both groups. By contrast, the Morbidity and mortality after Stroke, Eprosartan compared with nitrendipine for Secondary prevention (MOSES) study (n = 1405) generated results which differed from the VALUE study, in that blood pressure was reduced by both eprosartan and nitrendipine, but eprosartan reduced all cardiovascular and cerebrovascular events to a greater extent than nitrendipine. It is also possible that any delayed clinical benefit of eprosartan could be due to reverse cardiac remodelling. Eprosartan, by blocking AT II receptors, reducing noradrenaline release and blocking catecholamine actions, may, therefore, provide greater protection against vascular events than CCBs or other ARBs. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/18093411/Risk_reduction_by_preventing_stroke:_need_for_blockade_of_angiotensin_II_and_catecholamines L2 - http://www.tandfonline.com/doi/full/10.1185/030079907X260737 DB - PRIME DP - Unbound Medicine ER -