Arbs meds
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Summary
10 papers analyzed
Some studies suggest ARBs have benefits such as reducing inflammation, protecting against severe COVID-19, and lowering blood pressure, while other studies indicate potential risks like a modestly increased cancer risk and no clear cardiovascular protection benefits compared to ACEIs.
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The Role of Angiotensin Receptor Blockers (ARBs) in Cardiovascular Health and Beyond
Cardiovascular Outcomes in High-Risk Patients Without Heart Failure
Angiotensin II type 1 receptor antagonists (ARBs) are commonly used as an alternative to angiotensin-converting enzyme inhibitors (ACEIs) for patients without heart failure. However, their impact on cardiovascular morbidity and mortality remains uncertain. A systematic review and meta-analysis involving over 89,000 patients found that ARBs did not significantly reduce the risk of myocardial infarction (MI), cardiovascular death, or all-cause death compared to control groups. There was a trend towards fewer strokes in the ARB group, but the heterogeneity of the studies prevented a pooled risk estimate. This suggests that ARBs may not offer the same cardiovascular protection as ACEIs in non-heart failure patients.
ARBs and Cancer Risk
The potential link between ARBs and cancer risk has been a topic of concern. A meta-analysis of randomized controlled trials involving over 93,000 patients indicated a modestly increased risk of new cancer diagnoses among those taking ARBs, particularly lung cancer. However, no significant difference in cancer deaths was observed between the ARB and control groups. These findings highlight the need for further investigation to understand the cancer-related risks associated with ARBs.
ARBs in COVID-19 Patients
The COVID-19 pandemic has raised questions about the safety of ARBs, given their potential to increase ACE2 expression, the receptor for SARS-CoV-2. Studies have shown mixed results regarding the impact of ARBs on COVID-19 outcomes. A single-center retrospective study found that COVID-19 patients with hypertension who were treated with ARBs had lower levels of inflammatory markers and a trend towards lower mortality, although these differences were not statistically significant. Another meta-analysis concluded that ARBs did not increase the risk of severe or lethal COVID-19, supporting the continued use of these medications during the pandemic. Additionally, a literature review found no consistent evidence that ARBs increase ACE2 expression in humans, further supporting their safety in COVID-19 patients.
Blood Pressure Lowering Efficacy
ARBs are effective in lowering blood pressure in patients with primary hypertension. A review of 46 randomized controlled trials involving over 13,000 participants found that ARBs reduced systolic blood pressure by an average of 8 mm Hg and diastolic blood pressure by 5 mm Hg at maximum recommended doses. The blood pressure-lowering effect was similar across different ARBs, and higher doses did not significantly enhance this effect. This indicates that ARBs are a reliable option for managing hypertension.
ARBs and Exercise
The interaction between ARBs and exercise in controlling blood pressure has also been explored. A study involving hypertensive individuals with metabolic syndrome found that both ARBs and intense aerobic exercise independently lowered blood pressure. The combination of ARBs and exercise provided additive benefits, suggesting that patients can safely engage in exercise while on ARB therapy.
Conclusion
ARBs play a significant role in managing hypertension and have potential benefits in reducing inflammation and protecting against severe respiratory syndromes, including COVID-19. However, their impact on cardiovascular outcomes and cancer risk requires further investigation. Current evidence supports the continued use of ARBs in patients with hypertension, including those with COVID-19, while highlighting the need for ongoing research to fully understand their long-term effects.
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