Partial peroxisome proliferator-activated receptor agonist angiotensin receptor blockers. Potential multipronged strategy in stroke prevention.

BACKGROUND AND PURPOSE Although their primary mechanism of action is blood pressure lowering, emerging data suggest that select angiotensin receptor blockers (ARBs), which partially activate the peroxisome proliferator-activated receptor gamma (PPAR-gamma), may effectively treat insulin resistance and dyslipidemia without the toxicity sometimes associated with full PPAR-gamma agonists. Since up to 50% of the patients with ischemic stroke and transient ischemic attack harbor insulin resistance, drugs that simultaneously control hypertension and insulin resistance could be particularly useful for stroke prevention. SUMMARY OF REVIEW This review presents the experimental and preliminary clinical evidence supporting a promising role for partial PPAR-gamma agonist ARBs in treating insulin resistance and the metabolic syndrome in patients with ischemic cerebrovascular disease. CONCLUSION Partial PPAR-gamma agonist ARBs by virtue of their multiple beneficial mechanisms of action could provide a single multipronged strategy for reducing future vascular events in persons with, or at risk for, stroke.