In the last three decades, the evolution in the field of medical management of cardiovascular diseases has been absolutely impressive. The transition from an almost empiric approach to a pathophysiological strategy has characterized the new era of pharmacological treatment of most cardiovascular clinical conditions. In addition, the efficacy of modern drug treatment must be based on solid, unequivocal proofs deriving from large, rigorous studies (evidence-based medicine).
For any new class of cardiovascular drugs, rational, sound mechanism of action and indisputable safety and efficacy of major clinical end points, particularly reduction of cardiovascular morbidity and mortality, represent necessary requirements. As such, angiotensin AT1 receptor antagonists, or blockers (ARBs), are a paradigm of drug therapy of modern times.
In order to fulfill all the new criteria for cardiovascular drugs, the ARBs have been extensively, almost frantically, investigated. Being extremely interesting considering their rational mechanism of action, that is, the selective antagonism of angiotensin AT1 receptors - the main biological effector of the renin-angiotensin system (RAS) - the ARBs have been rigorously studied and tested in thousands of experimental and clinical investigations. Most recently, in view of the key pathophysiological role of the RAS in cardiovascular disease, the scientific medical community has focused on the potential advantages of ARBs in high-risk patients, the most rational target for preventive strategies.
The enormous, growing size, complexity, and, sometimes, discrepancies of the scientific literature on this topic, however, represent a tough challenge for all physicians who every day use ARBs in their practice. Undoubtedly, expert reviews of the available data and reports are very useful. The excellent work of Jan Schefe and Thomas Unger in this monograph provides a real state-of-the-art review of the scientific knowledge of ARBs, with a specific focus on their use in patients at high risk for cardiovascular events.
This text provides the essential notions on the biology, structural organization, physiology, and pathophysiology of the RAS, with a specific focus on the modern view of the network of angiotensin receptors, to which field the research groups led by Professor Unger have given important scientific contributions. In addition, the pharmacology of ARBs and the differences among the various compounds available today are presented synthetically to introduce the clinical applications of this new class of drugs. The broad range of clinical conditions in which ARBs have been tested is discussed extensively in well-organized separate sections and in a balanced way that I am sure will be much appreciated by the readers. Finally, the authors open a window on future studies that will definitely have a major impact on the clinical use of ARBs.
Overall, this work represents an extremely updated, knowledgeable, and balanced state-of-the-art review of this important new class of cardiovascular drugs and of the tremendous amount of information accumulated in this area in the last few years. I am quite confident that many colleagues will find this work very useful for updating their knowledge and driving their clinical practice.