Twisting arms to angiotensin receptor blockers/antagonists: the turn of cancer

Abstract

Treatment of cardiovascular disease has achieved spectacular targets in the last 30 years, significantly contributing to the dramatic increases in life expectancy. In contrast, in the recent years, very few pharmacological innovations have been proposed, most likely because of the escalating costs of drug clinical development and by the reduced needs of innovation in this field. Angiotensin receptor blockers/antagonists (ARBs) have represented one of the major novel class of drugs reaching the therapeutic use for cardiovascular disease indication. Given the extremely high prevalence of hypertension, the leading indication for ARBs, prescription of this class of drugs has increased to very high levels. It is calculated that about 200 million individuals are treated with ARBs on our planet and that this class covers ∼25% prescription of antihypertensive agents. Even though this may be due to intensive marketing activity, it is also related to their ‘friendly’ use recognized by both doctors and patients, being the best tolerated class among cardiovascular drugs,1,2 and to rigorous and impressive clinical development. In fact, beyond the 15-year clinical experience by physicians and the consequent long-term drug surveillance by the authorities of healthcare systems worldwide, until today more than 300 000 patients have been strictly monitored for periods averaging from 3 to 5 years in clinical trials performed in numerous different clinical settings [including hypertension, high cardiovascular risk, diabetes, heart failure, myocardial infarction (MI), renal failure, stroke, and atherosclerosis].3,4 In all these studies, adverse reactions ascribed to ARBs have generally been less than any comparator, and similar to placebo. Besides the setting of clinical trials, these drugs have been extensively investigated as indicated by more than 12 100 scientific publications on PubMed at the date of 3 July 2010, using only the keywords Angiotensin Receptor Antagonists and Angiotensin Receptor blockers. During …