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Numerosas evidencias han mostrado el papel deletéreo de angiotensina II en la lesión orgánica del paciente hipertenso. Así, el bloqueo del sistema renina-angiotensina se ha mostrado muy útil en la protección cardiovascular. Estudios en diabéticos con microalbuminuria (IRMA II) o nefropatía (RENAAL, IDNT) han demostrado la utilidad de los antagonistas de los receptores de la angiotensina II (ARA-II) en la protección cardiovascular del diabético. Tres grandes estudios han analizado la utilidad de ARA-II en la hipertensión: LIFE, SCOPE y VALUE. Hay que destacar que, hasta el momento, LIFE es el único estudio en que un fármaco antihipertensivo (ARA-II) se ha mostrado superior a otro (bloqueador beta) en términos de reducción de morbimortalidad, y los beneficios se han debido sobre todo a una significativa reducción del riesgo de ictus. El estudio SCOPE pudo también sugerir un cierto efecto protector de los ARA-II frente a eventos cerebrovasculares. Por último, VALUE ha destacado la relevancia de un adecuado y rápido control tensional en los hipertensos de alto riesgo pero, además, ha confirmado la utilidad de los ARA-II en aspectos que pueden ser muy importantes en la hipertensión, como la prevención de la diabetes. Con la información actualmente disponible, los ARA-II se muestran como fármacos antihipertensivos muy útiles, no sólo por su buena eficacia y excelente tolerabilidad, sino también por ofrecer efectos beneficiosos más allá de la propia reducción tensional.
Palabras clave:
Hipertensión arterial
Neuropatía
Diabetes
Hipertrofia ventricular izquierda
Antagonistas de los receptores de la angiotensina II
Numerous studies have shown the deleterious role of angiotensin II in organic lesions of hypertensive patients. Thus, the system renin-angiotensin blockade has been shown to be highly useful in cardiovascular protection. Studies in diabetics with microalbuminuria (IRMA II) or kidney disease (RENAAL, IDNT) have demonstrated the utility of angiotensin receptor blockers (ARB) in cardiovascular protection in diabetics. Three large studies have analyzed the utility of ARA II in hypertension: LIFE, SCOPE, and VALUE. Notably, to date, LIFE is the only study in which an antihypertensive drug (ARB) has been shown to be superior to another (beta-blocker) in reducing morbidity and mortality, benefits principally due to a significant reduction in the risk of stroke. The SCOPE study also suggested a certain protective effect of ARB against stroke. Lastly, VALUE has highlighted the importance of sufficient and rapid blood pressure control in hypertensive patients at high risk and has also confirmed the utility of ARB in factors that could be important in hypertension, such as diabetes prevention. Based on the currently available information, ARB have been shown to be highly useful antihypertensive drugs, not only because of their good efficacy and excellent tolerability, but also because they provide other beneficial effects in addition to blood pressure reduction.
Key words:
Hypertension
Nephropathy
Diabetes
Left ventricular hypertrophy
Angiotensin II receptor antagonists
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