Angiotensin II AT1 receptor antagonists' antihypertensive activity depends more on the specific drug and dose for the duration of effect rather than the magnitude of blood pressure reduction.
Systematic Review
Does ARB monotherapy reduce 24-h ambulatory blood pressure compared to placebo, amlodipine, or enalapril in hypertensive patients?
In patients taking ARBs, the dose administered primarily determines the duration of antihypertensive effect over 24 hours rather than the absolute magnitude of blood pressure reduction.
OBJECTIVE: To perform a systematic review of the antihypertensive activity of the angiotensin II AT1 receptor antagonists (ARB). METHODS: Studies in which blood pressure (BP) was measured using ambulatory BP monitoring for at least 24 h were collected from MEDLINE. Data for each treatment group, ARB, placebo or the drug used for its comparison were obtained from the selected studies. Only studies with a minimum of quality criteria were selected. The final study group contained 36 publications, with a total of 47 patient cohorts receiving ARB in monotherapy, 10 with placebo, 10 with amlodipine, and five with enalapril. The reduction in clinical and ambulatory BP during 24 h, day, night and the last 4-h period for each of the drugs analysed were calculated and adjusted by age, sex, number of participants and by the initial BP level. RESULTS: The global antihypertensive activity of ARB differs from that observed with amlodipine in the sense that the magnitude of the reduction in the BP values does not essentially depend on the initial BP values nor on the dose used. When only ARB were considered, the drug used was a determinant for systolic BP reduction, whereas for diastolic BP the influence was on the BP reduction and the duration of the antihypertensive activity. The dose used had a particular influence on the duration of the antihypertensive activity for both systolic and diastolic BP. CONCLUSION: Among the ARB, the influence is on duration more than on the magnitude of BP reduction. Dose, therefore, is an important factor in the duration of antihypertensive activity.
Fabià et al. (Mon,) conducted a systematic review in Hypertension. Angiotensin II AT1 receptor antagonists (ARB) vs. Placebo, amlodipine, and enalapril was evaluated on Reduction in clinical and ambulatory BP during 24 h, day, night and the last 4-h period. Angiotensin II AT1 receptor antagonists' antihypertensive activity depends more on the specific drug and dose for the duration of effect rather than the magnitude of blood pressure reduction.