Antihypertensive efficacy of angiotensin receptor blockers as monotherapy as evaluated by ambulatory blood pressure...

Area of Science:

• Cardiology
• Pharmacology
• Hypertension Management

Background:

• Angiotensin receptor blockers (ARBs) are frequently prescribed for hypertension.
• Dosing strategies often involve uptitration to achieve blood pressure goals.
• Limited data exist on the incremental benefits of uptitrating ARBs and comparative efficacy.

Purpose of the Study:

• To systematically review the antihypertensive efficacy of ARBs with dose escalation.
• To compare the 24-hour ambulatory blood pressure (ABP) lowering effect of losartan with other ARBs.

Main Methods:

• Systematic review of randomized clinical trials from PubMed, EMBASE, and Cochrane databases (until December 2012).
• Included studies reporting 24-hour ABP for commonly available ARBs in hypertensive patients.
• Analyzed ARB efficacy at 25%, 50%, and maximum doses, comparing losartan (50 and 100 mg) to other ARBs.

Main Results:

• Sixty-two studies with 15,289 patients were analyzed.
• A shallow dose-response curve was observed for ARBs, with modest ABP reductions.
• Losartan 50 mg and 100 mg demonstrated inferior blood pressure lowering compared to other ARBs at equivalent relative doses.

Conclusions:

• Uptitration of ARBs provides only marginal increases in antihypertensive efficacy.
• Losartan exhibited consistently lower efficacy than other ARBs, even at maximum doses.
• Findings suggest careful consideration of ARB choice and dosing strategies in hypertension management.