Los antagonistas de los receptores AT1 de la angiotensina II (ARA-II) son un grupo de fármacos que antagonizan las acciones que la angiotensina II (A-II) ejerce por mediación de éstos, independientemente de cuál sea su vía de síntesis. En presencia de un ARA-II, la A-II estimula los receptores AT2, produciendo diversas acciones que contrarrestan aquellas mediadas por los receptores AT1. Los ARA-II han demostrado ser fármacos antihipertensivos efectivos y seguros y, además, ejercen efectos beneficiosos independientes de su acción antihipertensiva en pacientes con insuficiencia cardiaca, diabetes mellitus tipo 2 y nefropatías. Sin embargo, existen diferencias en la estructura química, la afinidad receptiva y las propiedades farmacodinámicas y farmacocinéticas de estos fármacos. De hecho, recientemente se ha demostrado que los ARA-II ejercen acciones no relacionadas con el bloqueo de los receptores AT1 y que, por tanto, son características de cada uno de estos fármacos. En este artículo comparamos el mecanismo de acción, las acciones, las características farmacocinéticas y las reacciones adversas de los 7 ARA-II comercializados (candesartán, eprosartán, irbesartán, losartán, olmesartán, telmisartán y valsartán). Existen diferencias farmacológicas entre los ARA-II que sugieren que no podemos hablar de un efecto de clase. Sin embargo, aún no disponemos de ensayos clínicos adecuadamente diseñados que comparen sus efectos a largo plazo.
Palabras clave
Receptor AT1
Antagonistas de los receptores AT1
Hipertensión
Insuficiencia cardiaca
Diabetes mellitus
Farmacocinética
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