Volume 2, Number 1, March 2001

The role of angiotensin II AT₁-receptors in the regulation of the cerebral blood flow and brain ischaemia
Juan M Saavedra, Takeshi Ito, Yasuaki Nishimura

Continuous pretreatment with an ARB such as candesartan significantly prevented brain injury, indicating that this compound may be effective as a preventive treatment of neuronal injury in clinical conditions.
The goal of antihypertensive treatment is the prevention of end-organ damage. The question has been raised whether antihypertensive treatment with ACE-I or with ARB could prevent or reverse the cerebral complications arising from chronic hypertension. The overall effect of any agent is a result of the combined effect of the direct pharmacological influence of the drug on the diameter of cerebral blood vessels, added to the autoregulatory response to the fall in BP. Because they normalise autoregulation in hypertension without compromising normal CBF, ACE-I or ARB should be preferable to other antihypertensive medications such as calcium channel blockers (CCB), which could cause an excessive decrease in BP below the lower limit of autoregulation and may precipitate ischaemic stroke.⁶⁷ The hypothesis that modulation of the cerebral artery RAS could be of benefit for the treatment of human cerebrovascular disease, is supported by a large number of experimental data and some clinical studies and must be further confirmed with large-scale controlled clinical trials in hypertensive patients. In addition, elderly individuals are vulnerable to brain ischaemia and stroke, even in the absence of hypertension. During ageing, cerebral blood vessels alter their dilating capacity in a manner similar to that occurring in hypertensives. For this reason, it will be important to determine if the protective effect of ARB against brain ischaemia extends to ageing individuals as well.

JRAAS 2001;2:102-109.

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