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Improving the managed care of hypertension with angiotensin II antagonists
1Hypertension Center, Department of Surgical Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. mamls@earthlink.net
Insights
Angiotensin II antagonists (AIIAs) effectively manage hypertension with minimal side effects, improving patient adherence compared to other antihypertensive agents. This class of drugs offers a promising approach to long-term cardiovascular disease management.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Hypertension is a major modifiable cardiovascular disease risk factor requiring long-term management.
- Current antihypertensive treatments present challenges with patient adherence due to adverse effects.
- Improved hypertension management strategies are needed to prevent complications and reduce healthcare costs.
Purpose of the Study:
- To evaluate the efficacy and tolerability of Angiotensin II Antagonists (AIIAs) in managing hypertension.
- To compare the patient adherence rates of AIIAs with other antihypertensive drug classes.
- To explore the role of AIIAs in cardiovascular disease and heart failure management.
Main Methods:
- Review of studies on AIIAs, focusing on their mechanism of action and clinical outcomes.
- Analysis of patient refill rates in managed care settings for different antihypertensive classes.
- Comparison of losartan's unique properties, including titration and uricosuric effects.
Main Results:
- AIIAs effectively control hypertension with once-daily dosing and no significant adverse effects.
- Losartan demonstrates a higher refill rate in managed care settings, indicating better patient adherence.
- Certain AIIAs, including losartan, have shown benefits in managing congestive heart failure symptoms and mortality.
Conclusions:
- AIIAs represent an effective and well-tolerated therapeutic option for hypertension management.
- Improved patient adherence with AIIAs can lead to more efficient hypertension control.
- Combining AIIAs with lifestyle modifications and patient education enhances long-term cardiovascular health outcomes.
Abstract:
Among the modifiable risk factors for cardiovascular disease, hypertension is the most powerful and treatable. For an asymptomatic patient to remain on a lifetime of antihypertensive treatment that might cause adverse effects is difficult for most patients. Managed care plans should treat hypertensive patients in ways that the patient can remain on therapy to prevent complications and thereby reduce the long-term costs associated with untreated hypertension. The recent disappointing outcomes achieved with antihypertensive drugs suggest there is room for improvement in the management of hypertension. Since the introduction of the first orally active angiotensin II receptor blocking drug, losartan, attention has been focused on the central role of angiotensin II in hypertension and cardiovascular disease. Studies of angiotensin II antagonists (AIIAs), which block the tissue receptor for angiotensin II, show that these agents effectively control hypertension when given once daily and cause no significant adverse effects or laboratory abnormalities. Losartan is unique among the AIIAs in that it offers 1-step titration dosing and has a uricosuric effect. Losartan, candesartan, and valsartan have been shown to improve the symptoms of congestive heart failure; losartan has been similar to an angiotensin-converting enzyme inhibitor in reducing systolic dysfunction congestive heart failure mortality. At 1 year, the refill rate for losartan in a managed care setting has been more than that for any other class of antihypertensive agents. Although there is not yet a clinical trial determining the long term mortality of AIIA treatment in hypertension compared with other antihypertensive agents, the use of AIIAs in conjunction with lifestyle modification and patient education can provide more efficient hypertension control and a provide a treatment with which patients can live.