Angiotensin II Antagonists in the Treatment of Hypertension: More Similarities Than Differences

As the class of angiotensin-II antagonists expands, it becomes relevant to know if there are differences in antihypertensive efficacy among the various agents. Prior to regulatory approval, all agents have been evaluated vs. placebo. We excerpted the placebo-corrected reductions in diastolic blood pressure for angiotensin II antagonist monotherapy, using objective regulatory review data from the U.S. product circulars. Both systolic and diastolic blood pressure reductions were very similar. In 25 randomized clinical trials that compared angiotensin II antagonists to other classes, equivalent antihypertensive efficacy was demonstrated at recommended doses. Data pooled from 51 clinical trials showed comparable weighted average diastolic blood pressure reductions (not placebo-corrected) for monotherapy with losartan, valsartan, irbesartan, candesartan, and telmisartan. Reductions in systolic blood pressure paralleled the changes in diastolic blood pressure. Somewhat smaller responses were observed with eprosartan, although this was based on fewer patients. Thus, there appears to be little clinically significant difference in blood pressure efficacy among the six marketed angiotensin II antagonists in the treatment of hypertension. (c)2000 by Le Jacq Communications, Inc.