The role of angiotensin receptor blockers in CVD risk management.

Leonardo Grabinski Bottino, Flávio Danni Fuchs

Expert review of cardiovascular therapy 2020 Apr

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Introduction: Angiotensin receptor blockers (ARBs) are recommended as preferential drugs in the treatment of hypertension by guidelines. In this review, we reappraise their effectiveness to preventing major cardiovascular outcomes and the recent concerns with new adverse effects.Areas covered: ARBs were not superior to placebo in the prevention of all-cause deaths and combined cardiovascular events in seven randomized controlled trials (RCT). Several meta-analyses, with large number of participants, confirmed these findings. Three RCT trials, published in top journals, were retracted due to the uncertain reliability of their findings. Beside the low effectiveness in the prevention of cardiovascular disease (CVD), ARBs were implicated in one meta-analysis with an increased risk of cancer a finding that was not confirmed in another meta-analysis. In observational studies, ARBs were associated with a higher incidence of suicides. In addition, several lots of ARBs were contaminated with carcinogens.Expert opinion: ARBs have not been proven to reduce CVD risk and therefore should not be preferential drugs to treat hypertension. The implication of ARBs with suicide and cancer needs to be further studied.

Citation

Leonardo Grabinski Bottino, Flávio Danni Fuchs. The role of angiotensin receptor blockers in CVD risk management. Expert review of cardiovascular therapy. 2020 Apr;18(4):181-185