Related Experiment Video
Updated: Jun 24, 2026
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Irbesartan and hydrochlorothiazide association in the treatment of hypertension
Giuseppe Derosa1, Ilaria Ferrari, Arrigo F G Cicero
1Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. giuseppe.derosa@unipv.it
Insights
Irbesartan effectively controls blood pressure (BP) and offers kidney protection, especially in hypertensive patients with type 2 diabetes. Combining irbesartan with hydrochlorothiazide (HCTZ) enhances BP reduction with good tolerability.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Hypertension is a major vascular risk factor often poorly controlled.
- Inhibition of the renin-angiotensin-aldosterone system (RAAS) benefits hypertensive patients.
- Combining RAAS blockers with low-dose diuretics enhances efficacy and safety.
Purpose of the Study:
- To evaluate the efficacy and safety of irbesartan in managing hypertension.
- To assess the renoprotective effects of irbesartan in diabetic and non-diabetic nephropathy.
- To investigate the additive antihypertensive effects of irbesartan combined with hydrochlorothiazide (HCTZ).
Main Methods:
- Irbesartan, a selective angiotensin II receptor antagonist, was administered once daily.
- Comparative efficacy studies were conducted against other antihypertensive agents.
- Renoprotective effects were assessed in hypertensive type 2 diabetic patients and non-diabetic nephropathic patients.
- Fixed-dose combinations of irbesartan and HCTZ were evaluated for additive effects.
Main Results:
- Once-daily irbesartan provided 24-hour BP control.
- Irbesartan demonstrated comparable or superior BP reduction versus enalapril, atenolol, amlodipine, losartan, and valsartan.
- Irbesartan induced regression of left ventricular hypertrophy.
- Significant renoprotective effects were observed in hypertensive type 2 diabetic patients, with a lower risk of creatinine doubling compared to amlodipine or placebo.
- Irbesartan showed efficacy in non-diabetic nephropathic patients.
- Irbesartan exhibited peroxisome proliferator-activated receptor agonistic effects and beneficial impacts on inflammatory markers and endothelial function.
- Fixed-dose irbesartan/HCTZ combinations showed additive antihypertensive effects in a dose-dependent manner with high tolerability.
Conclusions:
- Irbesartan is an effective monotherapy for hypertension, offering 24-hour BP control, left ventricular hypertrophy regression, and significant renoprotection in diabetic and non-diabetic nephropathy.
- Combination therapy with irbesartan and HCTZ provides additive antihypertensive benefits with good tolerability.
- Further studies are needed to evaluate the end-organ protective effects of irbesartan-diuretic combinations.
Abstract:
Blood pressure (BP) is one of the most important and common vascular risk factors but it is often poorly controlled. Inhibition of the renin-angiotensin-aldosterone system (RAAS) provides beneficial effects in hypertensives. The association of low-dosed diuretics in combination with RAAS blocking agents allows maximum benefit from potassium depletion and control of compensatory increase in renin secretion, so increasing the efficacy and safety of RAAS blockers. Irbesartan is a potent and selective angiotensin II subtype 1 receptor antagonist indicated for use in patients with hypertension, including those with type 2 diabetes mellitus and nephropathy. Once-daily irbesartan administration provides 24h control of BP. In patients with mild-to-moderate hypertension, irbesartan was as effective as enalapril, atenolol and amlodipine, and more effective than losartan and valsartan in terms of absolute reduction in BP and response rate. Irbesartan also induced regression of left ventricular hypertrophy. Moreover, irbesartan 300 mg/day exerts a significant renoprotective effect in hypertensive type 2 diabetic patients. The relative risk of doubling of serum creatinine was significantly lower with irbesartan than amlodipine or placebo. Irbesartan was also effective in non-diabetic nephropatic patients. Moreover, irbesartan has peroxisome proliferator-activated receptor agonistic effects in in vitro studies, and it also demonstrated beneficial effects on inflammatory markers of atherosclerosis and endothelial function. The overall incidence of adverse events is similar to that of placebo. A fixed dose of hydrochlorothiazide (HCTZ) and irbesartan shows additive antihypertensive effect in a dose dependent manner up to HCTZ 25 mg and irbesartan 300 mg with high tolerability in diverse patient groups. Combination effects on end organ protection must be evaluated by broad spectrum studies. Ongoing trials about irbesartan and its combination with diuretics may provide necessary data to interpret the value of this association among others.
Related Concept Videos
01:25Antihypertensive Drugs: Direct Renin Inhibitors
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:15Antihypertensive Drugs: Thiazide-Class Diuretics
01:30Heart Failure V: Medical Management