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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article provides an update on controversies surrounding angiotensin receptor blockers (ARBs). Eight different ARBs are currently available, all with variable pharmacological properties. However, when considering a class effect, what applies to one drug may not necessarily pertain to all drugs in the class.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDementias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECognitive Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EReproductive Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDementias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERespiratory Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECognitive Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EReproductive Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDomenic Sica, MD, Virginia Commonwealth University Health System, Richmond, Virginia, USA, gave an update on controversies surrounding angiotensin receptor blockers (ARBs). Eight different ARBs are currently available, all with variable pharmacological properties (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Before reviewing meta-analyses of ARBs, Dr. Sica reminded the audience that when considering a class effect, what applies to one drug may not necessarily pertain to all drugs in the class.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13432\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13432\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13432\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003EPharmacology of Angiotensin Receptor Blockers\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EARBS AND CANCER\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EA 2010 meta-analysis by Sipahi et al. [\u003Cem\u003ELancet Oncol\u003C\/em\u003E] indicated that ARB treatment was associated with an increased risk of cancer. When 4 randomized trials with a secondary endpoint of cancer were combined, the authors found that patients treated with ARBs had an increased likelihood of a new cancer diagnosis (RR, 1.11; 95% CI, 1.04 to 1.18; p=0.001). A subsequent meta-analysis of 15 long-term trials found a neutral effect of ARBs when compared with non-ARB controls (OR, 1.00; 95% CI, 0.95 to 1.04) [ARB Trialists Collaboration. \u003Cem\u003EJ Hypertens\u003C\/em\u003E 2011]. The United States Food and Drug Administration issued a statement in 2011 stating that there was no evidence of increased risk of cancer linked to ARB use [US FDA. Safety Announcement. \u003Ca href=\u0022http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm257516.htm\u0022\u003Ehttp:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm257516.htm\u003C\/a\u003E. Published June 2, 2011. Accessed June 21, 2013]. \u201cIt\u0027s not been laid to rest completely, but most analyses suggest there is little such relationship,\u201d summarized Dr. Sica.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EARBs AND MYOCARDIAL INFARCTION\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EA 2004 nonquantitative review of ARBs and risk of myocardial infarction (MI) implied that ARB use was associated with an increased risk of MI [Verma S, Strauss M. \u003Cem\u003EBMJ\u003C\/em\u003E]. However, this idea was not supported in subsequent systematic review that included 19 trials (OR, 0.94 vs placebo; 95% CI, 0.75 to 1.16) [McDonald MA et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2005]. A 2011 meta-analysis of 37 randomized trials further supported the idea that ARBs are not associated with an increased risk of MI (OR, 1.01; 95% CI, 0.96 to 1.06) [Bangalore S et al. \u003Cem\u003EBMJ\u003C\/em\u003E].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EARBs AND DEMENTIA\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EMore studies are needed to determine the effect of ARB treatment on dementia, particularly Alzheimer disease (AD). There were no differences in Mini-Mental Status Examination (MMSE) scores overall in the Study on Cognition and Prognosis in the Elderly trial [SCOPE; [Skoog I et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 2005]. However, in patients with a baseline MMSE score of 24 to 28, those taking candesartan had smaller declines in MMSE than controls (mean difference, 0.49; 95% CI, 0.02 to 0.97; p=0.04). A large study using the US Veterans Affairs administrative database of 819,491 patients (\u223c98% male) suggested that ARB use was associated with a lower risk of AD compared with angiotensin-converting-enzyme inhibitors (HR, 0.81; 95% CI, 0.68 to 0.96; p=0.016) [Li NC et al. \u003Cem\u003EBMJ\u003C\/em\u003E 2010]. Results from 3 smaller studies also indicated that older patients with hypertension taking ARBs may have better cognitive functioning [Tedesco MA et al. \u003Cem\u003EAm J Hypertens\u003C\/em\u003E 1999; Fogari R et al. \u003Cem\u003EJ Hum Hypertens\u003C\/em\u003E 2006; Hajjar I et al. \u003Cem\u003EArch Int Med\u003C\/em\u003E 2012]\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EIn conclusion, it is unlikely that ARBs increase the risk of cancer or of MI but it remains uncertain whether they can prevent dementia, particularly AD. Additional large scale studies would further clarify the effects of ARB treatment.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/9\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznuy2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznuy2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}