Moreover, in comparative studies against losartan (Garcia Puig et al 1999) or telmisartan (De Rosa et al 2004), no differences were observed in BP reduction. Conclusion The ARB eprosartan has been shown to be superior to the calcium channel blocker nitrendipine in preventing cardiovascular disease in hypertensive stroke patients. dysfunction, inflammation, and remodelling, as well as a direct neuroprotective effect mediated through the activation of the angiotensin II type-2 receptor. In addition, a sympathoinhibition observed with the reninCangiotensin system blockers and particularly exhibited with eprosartan, may help to explain the better cardiovascular and cerebrovascular protection in comparison with the calcium antagonist nitrendipine. strong class=”kwd-title” Keywords: eprosartan, angiotensin-receptor blockers, hypertension, stroke, organ protection Introduction Cardiovascular disease is the leading cause of death and disability in developed countries and arterial hypertension is one of the most powerful risk factors for developing such cardiovascular complications (Lewington 2002). The prevalence of hypertension is usually 4-epi-Chlortetracycline Hydrochloride increasing and reaches more than 50% in people aged over 60 (Wolf-Maier et al 2003). The residual life-time risk for developing hypertension is usually higher than 90% (Vasan et al 2002). The pathogenesis and pathophysiology of essential hypertension is usually complex and entails both genetic and environmental aspects. However, it has become clear that both the reninCangiotensin system (RAS) and the sympathetic nervous system (SNS) play important functions in the development and maintenance of elevated blood pressure (BP) values and in the pathogenesis of target organ damage. Bearing this pathogenetic complexity in mind, therapeutic methods for hypertension and cardiovascular diseases include the use of various, very different drug classes, including diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin-receptor blockers (ARB) (Chobanian et al 2003; GC 2003). Angiotensin-receptor blockers selectively antagonize the angiotensin II type 1 (AT1) receptor and counteract most of the deleterious actions of angiotensin II. Eprosartan is an ARB with a special chemical structure that may be relevant to its mechanism of action. The pharmacological properties and clinical efficacy and security of eprosartan have been previously examined (Plosker and Foster 2000; Robins and Scott 2005). In June 2005, an important study reported the superiority of eprosartan over the calcium channel blocker nitrendipine in cardiovascular protection of hypertensive patients with a previous stroke (Schrader et al 2005). The present paper reviews the main findings of this trial and tries to solution some questions posed after its publication. The importance of stroke prevention by ARB in general and eprosartan in particular are also discussed. The importance of stroke and the MOSES study Stroke is the most frequent Rabbit Polyclonal to FPR1 cardiovascular complication in hypertensive patients older 4-epi-Chlortetracycline Hydrochloride than 60. A retrospective analysis of clinical trials in hypertensive patients published from 1991 to 2000 that included 59 550 randomized patients revealed that the total quantity of strokes (2533 events; 4.25%) clearly exceeded coronary events (1927 events; 3.24%) (Kjeldsen et al 2001). Blood pressure reduction and control is extremely important to prevent both stroke appearance (Collins et al 1990; Staessen et al 2000) and recurrence (PROGRESS 2000). Comparative trials and meta-analyses suggest that among different antihypertensive treatments, calcium channel blockers seem to represent the most powerful option for stroke prevention (Turnbull 2003; Angeli et al 2004). No comparative trials between different antihypertensive drug classes were reported before the Morbidity and Mortality after Stroke, Eprosartan compared with Nitrendipine for Secondary Prevention (MOSES) study. The MOSES investigators hypothesized that for the same BP reduction, the ARB eprosartan would be superior to 4-epi-Chlortetracycline Hydrochloride the calcium channel blocker nitrendipine in the cardiovascular protection of hypertensive patients with a previous stroke. Nitrendipine was chosen as a comparative drug on the basis of the cardiovascular and cerebrovascular protection observed in two trials of patients with isolated systolic hypertension (Staessen et al 1997; Wang et al 2000) and, as mentioned above, due to the fact that calcium channel blockers seem to be more protective against stroke than other antihypertensive drug classes. A total of 1405 patients with a previous cerebrovascular event (ischemic stroke, transitory ischemic attack, or cerebral hemorrhage) who were hypertensive (by both clinical measurements and ambulatory BP monitoring) were randomized to receive eprosartan 600 mg once daily or nitrendipine 10 mg once daily. Higher doses or combination therapy (excluding ARB and calcium channel blockers) were used in order to achieve a target BP lower than 140/90 mmHg. The primary endpoint was the composite of total mortality and all cardiovascular and cerebrovascular events, including all recurrent events. The principal results of the MOSES trial revealed the superiority of eprosartan over nitrendipine in the primary endpoint (Physique 1). There were 206 main endpoints in the eprosartan group (incidence density per 100 person-years [ID] of 13.25).