Angiotensin II antagonists for hypertension: Are there differences in efficacy?

Angiotensin II antagonists for hypertension: Are there differences in efficacy?

Author Conlin, P. R. Google Scholar
Spence, J. D. Google Scholar
Williams, B. Google Scholar
Ribeiro, A. B. Google Scholar
Saito, I Google Scholar
Benedict, C. Google Scholar
Bunt, AMG Google Scholar
Institution Brigham & Womens Hosp
Harvard Univ
Univ Western Ontario
Univ Leicester
Universidade Federal de São Paulo (UNIFESP)
Keio Univ
Univ Texas
Merck & Co Inc
Abstract We compared the antihypertensive efficacy of available drugs in the new angiotensin-II-antagonist (AIIA) class. the antihypertensive efficacy of losartan, valsartan, irbesartan, and candesartan was evaluated from randomized controlled trials (RCT) by performing a metaanalysis of 43 published RCT. These trials involved AIIA compared with placebo, other antihypertensive classes, and direct comparisons between AIIA. A weighted-average for diastolic and systolic blood pressure reduction with AIIA monotherapy, dose titration, and with addition of low-dose hydrochlorothiazide (HCTZ) were calculated. Weighted-average responder rates were also determined. the metaanalysis assessed a total of 11,281 patients. the absolute weighted-average reductions in diastolic (8.2 to 8.9 mm Hg) and systolic (10.4 to 11.8 mm Hg) blood pressure reductions (not placebo-corrected) for AIIA monotherapy were comparable for all AIIA. Responder rates for AIIA monotherapy were 48% to 55%. Dose titration resulted in slightly greater blood pressure reduction and an increase in responder rates to 53% to 63%. AIIA/hydrochlorothiazide combinations produced substantially greater reduction in systolic (16.1 to 20.6 mm Hg) and diastolic (9.9 to 13.6 mm Hg) blood pressure reductions than AIIA monotherapy and responder rates for AIIA/HCTZ combinations were 56% to 70%. This comprehensive analysis shows comparable antihypertensive efficacy within the AIIA class, a near-flat AIIA-dose response when titrating from starting to maximum recommended dose, and substantial potentiation of the antihypertensive effect with addition of HCTZ. (C) 2000 American Journal of Hypertension, Ltd.
Keywords hypertension
randomized controlled trials
Language English
Date 2000-04-01
Published in American Journal of Hypertension. New York: Elsevier B.V., v. 13, n. 4, p. 418-426, 2000.
ISSN 0895-7061 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 418-426
Access rights Closed access
Type Article
Web of Science ID WOS:000086954400016

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