Losartan 100 mg lowered 24-hour ambulatory systolic blood pressure less effectively than other ARBs at maximum dose by 3.9 mmHg (P=0.0002).
Meta-Analysis (n=15,289)
Does uptitration of ARBs or use of specific ARBs like losartan improve 24 h ambulatory blood pressure reduction in patients with hypertension?
Uptitration of ARBs provides only marginal additional blood pressure reduction, and losartan is consistently inferior to other ARBs in lowering 24-hour ambulatory blood pressure.
Mean Difference: 3.9
p-value: p=0.0002
AIMS: Angiotensin receptor blockers (ARBs) are available in different dosages and it is common clinical practice to uptitrate if blood pressure goal is not achieved with the initial dose. Data on the incremental antihypertensive efficacy with uptitration are scarce. It is also unclear if antihypertensive efficacy of losartan is comparable with other ARBs. METHODS AND RESULTS: We systematically reviewed PubMed/EMBASE/Cochrane databases for all randomized clinical trials until December 2012 reporting 24 h ambulatory blood pressure (ABP) for most commonly available ARBs in patients with hypertension. Reduction in ABP with ARBs was evaluated at 25% of the maximum (max) dose, 50% of the max dose, and at the max dose. Comparison was made between 24 h BP-lowering effect of losartan 50 and 100 mg and other ARBs at 50% max dose and the max dose, respectively. Sixty-two studies enrolling 15 289 patients (mean age 56 years; 60% men) with a mean duration of 10 weeks were included in the analysis. Overall, the dose-response curve with ARBs was shallow with decrease of 10.3/6.7 (systolic/diastolic), 11.7/7.6, and 13.0/8.3 mmHg with 25% max dose, 50% max dose, and with the max dose of ARBs, respectively. Losartan in the dose of 50 mg lowered ABP less well than other ARBs at 50% max dose by 2.5 mmHg systolic (P < 0.0001) and 1.8 mmHg diastolic (P = 0.0003). Losartan 100 mg lowered ABP less well than other ARBs at max dose by 3.9 mm Hg systolic (P = 0.0002) and 2.2 mmHg diastolic (P = 0.002). CONCLUSION: In this comprehensive analysis of the antihypertensive efficacy of ARBs by 24 h ABP, we observed a shallow dose-response curve, and uptitration marginally enhanced the antihypertensive efficacy. Blood pressure reduction with losartan at starting dose and at max dose was consistently inferior to the other ARBs.
Makani et al. (Wed,) conducted a meta-analysis in hypertension (n=15,289). Losartan vs. Other ARBs was evaluated on 24 h ambulatory systolic blood pressure reduction at maximum dose (MD 3.9 mmHg, p=0.0002). Losartan 100 mg lowered 24-hour ambulatory systolic blood pressure less effectively than other ARBs at maximum dose by 3.9 mmHg (P=0.0002).