Angiotensin receptor blockers for prevention of cardiovascular disease: where does the evidence stand?

Angiotensin receptor blockers (ARBs) are the most commonly used among blood pressure-lowering drugs worldwide, despite the absence of sound evidence of effectiveness in large and unbiased clinical trials. Meta-analyses published in recent years and reviewed here have not given support to this preference, suggesting that ARBs may be ineffective in the prevention of all cause mortality and major cardiovascular events (particularly myocardial infarction). There is evidence that ARB can be harmful for the kidney, particularly in patients with diabetes and in the elderly. It may be time to call for a moratorium on the preference for ARB in the management of hypertension and in patients with high cardiovascular risk.