Angiotensin II receptor blockers: the importance of dose in cardiovascular and renal risk reduction.

Numerous clinical studies have established that angiotensin II receptor blockers are effective as antihypertensive therapy and are well tolerated. Studies demonstrate that adding an angiotensin II receptor blocker to existing antihypertensive regimens reduces cardiovascular and renal risk, which may, in part, be a result of blocking the effects of angiotensin II. Though the antihypertensive dose response of these agents is well documented, the dose response for optimal target organ protection has not yet been clarified. A review of recent studies of angiotensin II receptor blockers in hypertension, acute myocardial infarction, heart failure, and nephropathy provide some data on specific drugs, doses, and risk reduction. Taken as a whole, these studies suggest the highest doses tested, which are at the upper limit of the antihypertensive range, provide greater risk reduction than lower doses. What is unknown is whether even higher doses or full-dose angiotensin II receptor blockers plus full-dose angiotensin-converting enzyme inhibitors might provide even greater risk reduction. Data from ongoing trials will provide additional insight.