Effective treatment of high blood pressure (BP) is a key strategy for reducing the burden of hypertension-related cardiovascular diseases, ie, mainly stroke, myocardial infarction, heart failure, and cardiovascular death. Despite these well-established concepts, however, hypertension remains poorly controlled worldwide. In addition, patients treated for hypertension often remain at a higher risk as compared to the normotensive population, even when a satisfactory BP control is achieved. This is due to the concomitant presence of metabolic abnormalities and/or organ damage, thus accounting for the high or very high added cardiovascular risk profile often observed in patients with hypertension. An emerging strategy to improve general BP control and achieve this unmet target for cardiovascular disease prevention in patients with hypertension is represented by a more extensive use of rational and effective antihypertensive therapies, based on drugs inhibiting the renin-angiotensin system. These drugs have, indeed, been demonstrated to be effective and safe in lowering both systolic and diastolic BP levels with a good tolerability and safety profile. In addition, these strategies seem to have a better impact than other antihypertensive drugs in terms of metabolic profile, as well as in terms of more effective cardiovascular protection compared to conventional antihypertensive therapies. Among the antihypertensive drugs able to counteract the deleterious effects of abnormal activation of the renin-angiotensin system, angiotensin II receptor blockers (ARBs) have been demonstrated to provide an unsurpassed tolerability profile and excellent cardiovascular protection to hypertension-related organ damage in randomized controlled clinical trials, in the presence of an antihypertensive efficacy and safety comparable to other antihypertensive drugs. In particular, these drugs are characterized by low rates of drug-related side effects, better compliance and adherence to prescribed antihypertensive regimens, and a wide range for use in synergistic and rational combination therapies, all factors that may contribute to improved BP control and reduced discontinuation from antihypertensive therapy in patients treated for hypertension. However, even with ARBs used in combination therapies in randomized clinical trials, the individual cardiovascular risk remains high. More recently, a new drug in the ARB class has been developed and approved for treating hypertension. Evidence demonstrating the good efficacy and safety profile of the ARB azilsartan medoxomil compared to other ARB agents in terms of BP reduction, both clinic and 24-h BP, are available. In particular, clinical trials have demonstrated the sustained antihypertensive efficacy of azilsartan-based therapy over the 24-h period and the high rate of BP control and normalization in patients with hypertension at different cardiovascular risk profiles. A growing number of randomized, controlled clinical trials are currently exploring the potential benefits achieved by this drug in terms of BP reduction and cardiovascular protection in patients with hypertension at different cardiovascular risk profiles compared to that of other ARBs or antihypertensive drug classes. This development may provide a solid perspective to achieve further reduction in cardiovascular residual risk, when an ARB-based therapeutic strategy is adopted.
ASJC Scopus subject areas
- Internal Medicine
- Cardiology and Cardiovascular Medicine