Comparative safety and tolerability of angiotensin II receptor antagonists.

Hypertension is a very common disease and represents a major risk factor for cardiovascular adverse events such as stroke and heart failure. In recent years, a big effort has been put into detecting and treating patients with hypertension. Several classes of drugs acting by different pharmacological mechanisms can be chosen for the treatment of hypertension. However, the long term use of all anti-hypertensive agents is sometimes limited by the occurrence of adverse effects. Thanks to continuous pharmacological research, new compounds are regularly developed and become available in clinical practice. Recently, several new, nonpeptide, orally active angiotensin II receptor antagonists have reached the market. Today, these substances represent the most specific way to block the renin angiotensin system. Numerous studies have now demonstrated that these angiotensin II antagonists are as effective as ACE inhibitors, calcium antagonists, beta-blockers or diuretics in lowering blood pressure in patients with hypertension. Given the increasing use of angiotensin II receptor antagonists in the treatment of hypertension, it is important to review their safety and tolerability. Based on the actual level of knowledge, the striking feature of this class of agents is their favourable safety and tolerability profile which appears to be equivalent to that observed with placebo. Indeed, so far, no clear class-specific adverse effect has been attributed to the angiotensin II receptor antagonists. Thus, if angiotensin II antagonists prevent target organ damage and reduce the morbidity and mortality of patients with hypertension, they may well become a first-line treatment of hypertension.