Angiotensin type 1 receptor antagonists - A novel approach to augmenting posttraumatic stress disorder and phobia therapies?

摘要

The renin-angiotensin system system, which includes the renin and angiotensin-converting enzyme pathways, and its primary effector peptide angiotensin II (All) acting through its two cognate receptors, ATI and AT2 receptors, has been known for >70 years as a major regulator of vascular tone and fluid metabolism (1). Angiotensin receptor blockers (ARBs), consisting of a group of orally active drugs such as losartan (the group is often referred to as the "sartans"), and angiotensin-converting enzyme inhibitors are currently mainstream treatments for essential hypertension and some aspects of diabetes. In addition to these peripheral effects, All and AT1 receptors are widely distributed in the brain and are being implicated in the regulation of many brain functions, including cerebral circulation, inflammation, neuroendocrine responses, learning, and memory (2). Because many ARBs are already on the market and have a good safety record with long-term use, they would be particularly attractive candidates to be used as novel treatments for central nervous system disorders where current therapies are inadequate. The article by Marvar et al. (3) in this issue of Biological Psychiatry may provide a strong impetus to consider testing ARBs, particularly as an adjunct therapy to augment cognitive-behavioral therapy, in posttraumatic stress disorder (PTSD) and phobias.