Efficacy of angiotensin II antagonists in hypertension

Advertising claims of superior antihypertensive efficacy of one angiotensin antagonist over another are not substantiated by a review of available evidence from 43 randomized, controlled clinical trials, in which 11,281 patients were included. There were no clinically important differences among the drugs. At initial doses, the mean reduction of diastolic pressure was 8.5 mmHg and of systolic pressure was 10.7 mmHg; 50% were responders. Doubling the dose of these agents produced only small additional blood pressure reduction. Diastolic blood pressure fell by an additional 1.5 mmHg, and systolic blood pressure by 2.5 mmHg; there were only 7% more responders. In contrast, the addition of hydrochlorothiazide 12.5 mg daily to the initial doses provided 40% to 60% more reduction of blood pressure and 40% more responders. The author concludes that adding hydrochlorothiazide to any angiotensin II antagonist results in much greater efficacy than switching or increasing doses of the angiotensin II antagonist.