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An The Roll of ARBs in Hypertension
An The Roll of ARBs in Hypertension
Hypertension
Introduction of RAAS…
There are many important factors that together keep the blood pressure at a
certain level. A central role in maintaining the blood pressure is played by a
chain of key hormonal reactions. The first step in the chain is the production
of renin in the kidneys when the kidneys detect lower blood pressure. The
renin stimulates the formation of a protein called angiotensin I, which is then
converted to angiotensin II by the angiotensin- converting enzyme in the
lungs. Angiotensin II is the most powerful constrictor of blood vessels known.
This effect of constricting blood vessels tends to elevate the blood pressure.
Angiotensin II also causes the secretion of an additional blood pressure
elevating hormone in the adrenal glands, called aldosterone.
This chain of blood pressure regulating hormones is referred to as the renin-
angiotensin-aldosterone (RAA) hormonal system.
Blocking of RAAS through medicine..
AT1 Receptor:
Vasoconstriction,
Sympathetic activation,
Cellular growth,
Fibrosis, Thrombosis
AT2 Receptor:
Vasodilation, Apoptosis,
Inhibition of cellular
growth
For What
Conditions ARBs are Used?
Losartan
Valsartan
Irbesartan
Candesartan
Telmisartan
Eprosartan
Olmesartan
Clinical use of Candesartan…
we reported that patients who had taken valsartan demonstrated a particularly large
morning surge, and a significant difference (p = 0.02) was observed compared to that in
those taking candesartan (ATOM study). Methods and Subjects Patients in our outpatient
clinic diagnosed with morning hypertension (over 135/85mmHg), who were already being
treated with valsartan, were changed to candesartan. We estimated, from home blood
pressure, the differences in morning and evening blood pressure values after changing the
medication. Results We investigated 28 morning hypertension patients (men, 14 ; women,
14) who were previously prescribed valsartan, and then changed to candesartan. After
changing to candesartan, systolic blood pressure and diastolic blood pressure recorded in
the outpatient clinic decreased (145.8 ± 13.9mmHg vs. 138.7 ± 13.3mmHg ; 76.7 ±
9.9mmHg vs. 72.8 ± 7.1mmHg, p = 0.0011, p = 0.0230, respectively). Moreover, the
average early morning blood pressure decreased significantly (150.1 ± 10.7mmHg vs.
142.0 ± 14.5mmHg, p = 0.0002). Changes in the differences in blood pressure values
between early morning and evening were largest in patients who changed from valsartan
to candesartan (17.6 ±10.2mmHg vs. 11.9 ± 14.8mmHg, p=0.0120). Conclusion It was
shown that a medication change to candesartan from valsartan is effective in morning
hypertensive patients.
Comparison of effects of losartan, irbesartan,
and candesartanon flow-mediated brachial artery dilation and
on inflammatory and thrombolytic markers in patients with
systemic hypertension