Angiotensin II receptor antagonists (AIIRA) in the subclinical organ damage

The presence of sub-clinical anatomical and functional damage implies the development of major cardiovascular events. A number of studies indicate that the use of AIIRA is effective in the prevention of sub-clinical organ damage. Angiotensin II, at a cardiac level, facilitates the remodelling processes independent of its hypertensive effect. Recent data from hypertensive patients show that AT(1) receptor inhibition by AIIRA reduces left ventricular mass, fibrosis as well as myocardial collagen content. Other studies provide further evidence of its antiarrhythmic action and the benefits on sudden death risk. Angiotensin II also plays a role in the pathogenesis of renal damage. The nephroprotective effects of AIIRA are largely due to the reduction in albuminuria, which represents a therapeutic target and a risk indicator for the loss of renal function in patients with diabetic nephropathy. At vascular level, angiotensin II not only promotes atherosclerotic plaque formation and rupture but also thrombogenesis. The decrease in the incidence of stroke in patients treated with AIIRA appears to confirm their effectiveness in improving plaque stability and to reduce oxidative stress. Finally, AIIRA have been shown to have antidiabetic effects thought to due to AIIRA interfering with angiotensin II-mediated intracellular transduction.