madman
Super Moderator
Abstract
Angiotensin-receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin-receptor blockers may be more effective than the older ones. A network meta-analysis was performed to compare the efficacy of various angiotensin-receptor blockers in reducing office and ambulatory blood pressure in hypertensive patients. Relevant literature was searched from English and Chinese databases for randomized controlled trials involving angiotensin receptor blockers in hypertension. Efficacy variables included systolic and diastolic blood pressure either in the office or on ambulatory blood pressure monitoring. Absolute blood pressure reductions at 6-12 weeks of treatment and their credible intervals were reported. A total of 34 publications provided adequate data for analysis (n = 14 859). In 28 studies on office systolic blood pressure (n = 12 731), against the common comparator valsartan 80 mg, the differences in systolic blood pressure were in favor of azilsartan medoxomil (20-80 mg), irbesartan (300 mg), olmesartan (20-40 mg), telmisartan (80 mg), and valsartan (160-320 mg), but not candesartan (8-16 mg), losartan (50-100 mg), irbesartan (150 mg), olmesartan (10 mg), and telmisartan (40 mg). The ranking plot shows that azilsartan medoxomil 80 mg had a possibility of 99% being the best in the class. Similar results were observed for the office diastolic blood pressure and from 13 studies for 24-hour ambulatory systolic and diastolic blood pressure.
*In conclusion, angiotensin-receptor blockers had different blood pressure-lowering efficacy. The newest angiotensin-receptor blocker azilsartan medoxomil at the dose of 80 mg seemed to be most efficacious in reducing both systolic and diastolic blood pressure in the office and on ambulatory measurement.
1 | INTRODUCTION
Angiotensin-receptor blockers are recommended by the current hypertension guidelines as one of the first-line antihypertensive drug classes. Angiotensin-receptor blockers lower blood pressures by inhibiting the actions of angiotensin II and exhibit good tolerability.1 Until recently, a number of agents in this class are available for the treatment of hypertension.2 However, since the first angiotensin-receptor blocker, losartan, became available, this class of drugs has been unsatisfied for their less or low potency in blood pressure lowering. Some newer agents had been seen as more efficacious than the older ones, but eventually found that the dosage might not be equivalent. The more potent blood pressure-lowering action was with a problem of more side effects.
Recent technological advances have led to the discovery of a structurally and chemically even newer agent, azilsartan medoxomil. In clinical studies, this new angiotensin-receptor blocker showed strong blood pressure-lowering efficacy with similar tolerability and side effects. This new drug has been compared with several but not all available older agents. We, therefore, performed the present network meta-analysis in an attempt to have an overview of this class of antihypertensive drugs in patients with hypertension, with the focus on the efficacy of azilsartan medoxomil at various dosages.
*In conclusion, our study showed that angiotensin-receptor blockers had different blood pressure-lowering efficacy, with the newest one, azilsartan medoxomil, being most efficacious in reducing both office and ambulatory blood pressures, at the least during short-term treatment (<12 weeks). With the increasing availability, azilsartan medoxomil might improve blood pressure control. Nonetheless, more evidence on this new angiotensin-receptor blocker is still needed.
Angiotensin-receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin-receptor blockers may be more effective than the older ones. A network meta-analysis was performed to compare the efficacy of various angiotensin-receptor blockers in reducing office and ambulatory blood pressure in hypertensive patients. Relevant literature was searched from English and Chinese databases for randomized controlled trials involving angiotensin receptor blockers in hypertension. Efficacy variables included systolic and diastolic blood pressure either in the office or on ambulatory blood pressure monitoring. Absolute blood pressure reductions at 6-12 weeks of treatment and their credible intervals were reported. A total of 34 publications provided adequate data for analysis (n = 14 859). In 28 studies on office systolic blood pressure (n = 12 731), against the common comparator valsartan 80 mg, the differences in systolic blood pressure were in favor of azilsartan medoxomil (20-80 mg), irbesartan (300 mg), olmesartan (20-40 mg), telmisartan (80 mg), and valsartan (160-320 mg), but not candesartan (8-16 mg), losartan (50-100 mg), irbesartan (150 mg), olmesartan (10 mg), and telmisartan (40 mg). The ranking plot shows that azilsartan medoxomil 80 mg had a possibility of 99% being the best in the class. Similar results were observed for the office diastolic blood pressure and from 13 studies for 24-hour ambulatory systolic and diastolic blood pressure.
*In conclusion, angiotensin-receptor blockers had different blood pressure-lowering efficacy. The newest angiotensin-receptor blocker azilsartan medoxomil at the dose of 80 mg seemed to be most efficacious in reducing both systolic and diastolic blood pressure in the office and on ambulatory measurement.
1 | INTRODUCTION
Angiotensin-receptor blockers are recommended by the current hypertension guidelines as one of the first-line antihypertensive drug classes. Angiotensin-receptor blockers lower blood pressures by inhibiting the actions of angiotensin II and exhibit good tolerability.1 Until recently, a number of agents in this class are available for the treatment of hypertension.2 However, since the first angiotensin-receptor blocker, losartan, became available, this class of drugs has been unsatisfied for their less or low potency in blood pressure lowering. Some newer agents had been seen as more efficacious than the older ones, but eventually found that the dosage might not be equivalent. The more potent blood pressure-lowering action was with a problem of more side effects.
Recent technological advances have led to the discovery of a structurally and chemically even newer agent, azilsartan medoxomil. In clinical studies, this new angiotensin-receptor blocker showed strong blood pressure-lowering efficacy with similar tolerability and side effects. This new drug has been compared with several but not all available older agents. We, therefore, performed the present network meta-analysis in an attempt to have an overview of this class of antihypertensive drugs in patients with hypertension, with the focus on the efficacy of azilsartan medoxomil at various dosages.
*In conclusion, our study showed that angiotensin-receptor blockers had different blood pressure-lowering efficacy, with the newest one, azilsartan medoxomil, being most efficacious in reducing both office and ambulatory blood pressures, at the least during short-term treatment (<12 weeks). With the increasing availability, azilsartan medoxomil might improve blood pressure control. Nonetheless, more evidence on this new angiotensin-receptor blocker is still needed.
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