aredmunnd OF 14 ati 2 G1) madanluaidaniumsimnanevalaaunar “Angiotensin Il Receptor Blocker (ARBs)” aniinl aaron Amornrate Sastravaha EUU Renin - Angiotensin - Aldosterone System (RAAS) fidausaAqysiodame vouthah muquarinmulatia auqeinfoutuanituinanae mavstryuar remodeling vesiiedeluln Wala uss seuuMAamien aeuu RAAS UszneuAae 1) angiotensin viawthAdluensdadunesseuy RAAS af aeqandy 2) renin dswevilaa! vawiinfitian angiotensin ‘uuu angiotensin | 3) angiotensin - converting enzyme (ACE) \dhudulasivinwtinfulauu angiotensin | uth angiotensin II 4) angiotensin II ifluanaeenqndiidamqynesszuu RAAS Felunvaealnfiuacaaetil neBammfinduludrane lavduty angiotensin Il receptor 5) angiotensin Il receptor yothfiauriy angiotensin II Le aos *e. 6) aldosterone Wuseflaweenqysnauqunaiiuinaausiari Taula saan = +“ msfanrmnanfrtiindnsides nousiieounnumrant anne daunwasarans usin nine Department of Companion Animal Clinical Sciences, The Faculty of Veterinary Medicine, Kasetsart University, Bangkean, Bangkok 10900G18) menatinaurnd OF 14 osha 2 Renin catalyzes ola Angiotensin 1 ACE catalyzes ACE inhibitors sinuoa block . Angiotensin II Angiotensin-II ngiotensin Receptor antagonists > block renin — angiotensin - aldosterone AT, receptor AAT, receptor system (pressor effets) at x quit 1: uananalnnisat1s Angiotensin RAAS lussuufdaAg/lunimeuauososinameanraesialeduner uaznrae pmusilatings dlessiniiuansenudeanuduladin vRnnlafin seMuinfeusludsme caz anrudrumunaaaenumdaulee winiivanvseruy RAAS Aa nrsabr9 angiotensin Il law angiotensin II aveangqnalauaury angiotensin It receptor fancy ‘Wuurl angiotensin II receptor type | IAT) wae type I (AT) quit 1 masenqrignazdurle AT, receptor aenzedultuaanienunsaa Uaruuedt2 wiiiuncuienaaatonundaalarie uaciunrdulatian donations Viunfouastituineme Rnetanintuuecanaduluvaan@endstug) war Halertosna uuivindu uaznaeiurcuuulssandmtals uuudinwidiin (Sympathetic) vin iialafiudaunuas: Uhty Wofanntencaneintolauasiiuenudulatian mene AT, receptor ‘aifiuavin SEU RAS UMLIMYES AT, receptor tuaHasiTu tissue diferentiation WA developmentaraeradmaunmnd OF 14 uth 2 G19) nosfinw1 RAAS waZnrsAuWuEIuNg angiotensin converting enzyme inhibitor (ACEI) ahbininnneladuueauacratetannvnduladings dilse@vBnawdguain Toe ACEI fubvrvaunnldow angiotensin t tukfl angiotensin | 4aava7Ae angiotensin converting enzyme Wat: ACE! fiafinatiudianreaarudanes bradykinin Faiths potent vasodilator usiaannasAnwnniawn yarn dieléSuurtungas ACEI ‘ur + aeélezay angiotensin II iingstu levsaniewlealau ansoulaen angiotensin | tilts angiotensin 1! ‘Wun chymostatin - sensitive angiotensin ¢ generating ‘enzyme (CAGE), cathepsins G way Hhdnaty Ala chymase 018 Chymase pathway dodlusruundnty fawGuw angiotensin | elu angiotensin Il Hnsiwmaaa@eanues uaendrudderila iiinnvas wurla thypertophy Was: hyperplasia) Sufhunatrudarsuuvalauarnaaniian saunas lien Angiotensin receptor blockers (ARBs) ‘iiqniéeiudlatl angiotensin Il receptor Tnemesndnaz Winanas Hrniirin iessanurtungy ACEI hisnansnansesu angiotensin Il Tuan wavluetuazee 4 Wiannysol iu ‘luvicleasilaifiesS exes 20 inary angiotensin || daulugflumalagnains vn wulost Guwensin ACE vi cardiac chymase dauqvitinausilitilszaed ARBs Mavmuensisanh ARBs ‘Lifluanz=mucionrsa%s prostaglandin wasnravivarw bradykinin wilew ACEI waliliin pmudilafingadioundu llonyaliur , Tv Win angioedema uaclavirbhfiannsle trvlun angiotensin receptor blockers ARBs) Sqnumualavuthudnnusawaosety Aquvna 1. fiaanananentunneay fu AT, receptor Ilanin Tatts AT, receptor iat 2. tayndiaine¥uru plasma protein gawin (ausiauae 90-99.) 3. ARBs ynéia unv¥u candesartan celexefil HuaannrawrAuiuran Losartan ifhutisoumntungu ARBs lntuilu competitive antagonist Hariwlaua: hiwrewoneia AT, receptor Losartan logneouselé exp 3174 Gadluerserptusislqnigyna Losartan uasiizeuxaareanqvsenan’ EXP 3174 flaaaauaandy parent drug 10-40 wh Hunuom dhaqftunnstiudis vives angiotensin II nas Viiauiueriutlaaray. bydrochlorothiazide avifin lsBvimwWlumesnarnmulatio lnuliiaqnad rss Valsartan tf competitive antagonist si AT, receptor viuieinaru Losartan waltfha active « sale Py a yaw dug usciueantadbiaeugl faeesveinieengniuvand Losartan uollnsiueriy EXP 317442) arsendimunmd OF 14 ofl 2 Valsartan Saas uwrzela AT, receptor 19N47 losartan fa 20 wi widdlaifinsAnentaulsslond WNAAinveATUT WZ NlHdouNuetutlady: hydrochlorothiazide aifinlssA@vGn why meanrnumutatio Irbesartan tihs noncompetitive antagonist 90 AT, receptor ilu active drug fuaanain sranrusiludaulug) wana Irbesartan az4uriu AT, receptor find Losartan wszwins 9 wi way Suav@vBmwlumsananueulatinaind Losartan (uaz laiuansinsy1n enalapril) Candesartan \iw competitive antagonist sia AT, receptor axflugi! inactive usegn wldensheniee laainidlegngntn lwp active Candesartan Hlaaiudrunizia AT, receptor we ~ i, ., a winfiu Valsartan Candesartan azqnil@awsialuifl CV 15959 atilu inactive metabolite qnathutartliviclesasd 1 MsUAENWUL angioedema (a IM suaNLFanNALn wih) Duqvitnadusitdunnetiqnees captopril wutiauinty ACE dau awk ARBs naifin angioedema teend ACEI ualliananantit AABs Iwsreifin. angioedema ann ACE! Aaaulaenaflueingnawums prudutatinansinas (fin hypotension) HaiwAsnasGaltiu unwind +] uannea aunneruna wien nasvenunesladiewndi msde tundas ARBs tunsdifitinniaemaeslafinnd auvawe Ws heart failue Hlnvay hypovolemia Uae/vta hypotension danvganrsifia bilateral renal artery stenosis ava Vimiavineuedlmanas auifnnnizlaneaeuNauld moiowuel misolmeneiva Tune tieanda ARB siindaaannrstdentundw ACEI wiftmasfierse atiseunan unsRiamumereuserlnad sina nisAnw vai 7 wud evungy ARBs AT9AANIAIMA albuminuria Naaifin hyperkalemia ‘ings ARBs daunU potassium supplement vita entutladrey Feinuludaun (Ksparing diuretics) Iasvannelunsdiinravheuaasladolna Irena) insufficiency) woitinfiarsnuidoutuansnsrarcAulieduntudenasinane masliy ARBs lunstiifinasvineuneslafioniia (renal insufficiency) z\fiannae hyperkalemia ‘Witiaunt ACE 1craamadmunnd BH 14 atid 2 G2) mafinunnavasetlungy ARBs lulsamasiataaninad Junailifimaineunonilatasdinuanes uasiinveialalndauday waitin fisnannnidantdidhudfauan Wud tungu ACEI maAnwaeseTlungy ARBs Ad aAtyluanlaurt ELUTE thunagAmerutiuudiuy Losartan 50 1un, vied fu Captopril 0 3n, Suar 3 Ak wusalill inven munnshreiuludesesiarmelons sarheusanvladunar uaensrusin Traviols Iunrafinenweamsinen 24) SnnavAinamdetdaagllaun vatHerT dhunrsdmean rain Valsartan 160 un. sin Ty lunrainenunestiemianeitedumes wou 21 wudtlaiilvasie formimuian wsilluaandarinimne Sarnnlawvnavasialemunes uaemismesin Taenernunasanavaetaledumaradrathindiaqy wanain Valsartan Saftuaviahinratudaves ete ate Moet, “ ead Wiverdaiieiu dloakarnauitaatiouas uaciqunwtinniw mafinunnanasenlunds ARBs Ilsandrnienalamesinmsiataan nnvAmerifuafiuentunda ARBs IuawhdaAgy ul OPITMAAL dllunasAnwa wivuifauaznds Losartan waz Captopril wud aidan vaanellaiuaneiastu usinga Captopril dluuaBivasdigammsmesiinds way VALIANT dhunasAnwanie len Valsartan, Captooril weunia 2afladautiy wud Valsartan Sualunrsangarimsmreludlamandrwiwinstwacnstion 24 dou Tailuadindamaldtnetiaslaceantis \udninnaeanuty nanyiduarnudulatings (spontaneous hypertensive rat) nnsli ARBs ani) ACE azanariudulatia War left ventricular weight foody weight ‘ainnda nisla wiaiiea uarwudreedy angiotensin | aanslungul urdu Gounarilunad uactudnt ronasiiinneintaduinay wut nsitn Benazeprilat SaNrTL Vaisartan 718 myocardial beta adrenergic response, MauEneMavasiialavosd22H1H (left ventricle) Maile vos left ventricle uax NgRMELAL catecholamine tudanlafindans lk ACEI usniinaea Gotha mnogu} uvtundu ARBs flueniiqeuauiiunaula essinenuenia funnsmeudwestes Renin-Angiotensin-Aldasterone system (AAAS) fidsuatesiarruustalauas wanton lunraeiialatinnvinvwanns ARBs waviluindadenniia vieldfouu ACE! Jumtinnnvetalsdumarlugiauacina somlsraunrenidiieulAiaely valsartan luqilait Wiunositiedy dafannesaladumeauuuquars lnelilumurndady 05 faainiuse Aang (Heueinawrauusiinvadn enalapril waz valsartan lunainwrguawnrvaladumartunn) witasndsbiiewanuushdriugiexacuny ussnauluennguiidiimergs dlevieuiiu unlungn ACE) SauusriniGasonmslieruawinen wisuAuiiniiiamagein uazsanie Fmnedinalndin(BD mreraginrunnd OF 14 ahah 2 lanansareas aunre Gundes, qovud Gvqa uaz auf useSaualeal 2546. Angiotensin Receptor Blocker , Text and Journal Publication Co., Ltd. , ngamnws 492. wif Cohn J.N. 2003. Angiotensin receptor blocker and clinical trial in heart failure. Eur Heart J. 24 125-9. Cohn J.N. and Tognoni G. 2001. A Randomized Trial of the angiotensin receptor blocker Valsartan in Chronic heart failure. N Eng J Med 345 : 1665-75. Goodfriend TL, Elliot ME. And Com KJ. 1996, Angiotensin receptors and their antagonists, N Eng J Med 334 : 1649-54, Opie CH 1995, Drug for the heart 4” . ed. W.B. Saunders Company, Philadelphia p 105-143 Preffer MAA. et al. 2003, Valsartan, Captopril or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Eng J Med 349: 1893-906. Product information : Atacand’ , condesartan cilexefil. Astrazeneca, Wayne, PA, reviewed 4/2000 Product information : Cozaar’, losartan . March & Co , Inc, west point , PA, reviewee 4/2000 Product information : Dioven’ , valsartan. Ciba-Geigy, Summit, NJ, 1998 Urata H, Behm KD, Philip A, Kinoshita A, Gabrovsek |, Bumpus FM, et al. 1993. Cellular localization and regional distribution of an angiotensin Il forming chymase in the heart. J. Clin Invest 91:1269-81