Key result
Losartan is an effective antihypertensive agent with an adverse effect profile similar to placebo and a reduced incidence of cough compared to ACE inhibitors.
Why the study?
Does losartan effectively lower blood pressure with a favorable adverse effect profile compared to ACE inhibitors or placebo in patients with hypertension?
Does losartan effectively lower blood pressure with a favorable adverse effect profile compared to ACE inhibitors or placebo in patients with hypertension?
Losartan provides similar antihypertensive efficacy to ACE inhibitors but with a placebo-like side effect profile, particularly less cough, making it a viable alternative for ACE inhibitor-intolerant patients.
Answers are grounded in this paper and cite their sources.
Supports losartan for ACEI-intolerant hypertensives; leaves open comparative effectiveness versus contemporary ARBs.
OBJECTIVE: To describe a new class of antihypertensive agents, the angiotensin II receptor antagonists, with emphasis on the prototype losartan. Pharmacokinetic data and clinical trials are reviewed, as well as adverse reactions, drug interactions, and dosing guidelines. DATA SOURCES: A MEDLINE search of English-language literature published from 1966 through 1995 was performed. In addition, Merck and Co. provided bibliographic data on file for losartan. STUDY SELECTION: Emphasis was placed on clinical and pharmacokinetic studies in humans. Controlled, double-blind studies were evaluated to assess the efficacy and adverse effect profile of losartan. DATA SYNTHESIS: Losartan is a nonpeptide, competitive antagonist of the type I angiotensin II receptor. In comparative clinical trials, losartan appears to have antihypertensive efficacy similar to that of the angiotensin-converting enzyme (ACE) inhibitors. Losartan is well tolerated, with an adverse effect profile similar to that of placebo and a reduced incidence of cough versus that with ACE inhibitors. A combination product consisting of losartan 50 mg and hydrochlorothiazide 12.5 mg has also received approval for the treatment of hypertension. The combination product is not indicated for initial therapy, but is recommended for patients who do not respond adequately to losartan monotherapy. The angiotensin II receptor antagonists are also being investigated for beneficial effects in patients with ventricular hypertrophy, renal disease, and heart failure. CONCLUSIONS: Losartan, the first angiotensin II receptor antagonist to receive approval for use in the US, appears to be an effective new antihypertensive agent with an adverse effect profile similar to that of placebo. Losartan may be an alternative for patients who cannot tolerate ACE inhibitors. However, the effect of losartan on mortality remains to be evaluated. The role of the angiotensin II receptor antagonists in areas such as ventricular hypertrophy, renal function, and heart failure has yet to be determined.
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Schaefer et al. (1996) conducted a review in Hypertension. Losartan vs. ACE inhibitors and placebo was evaluated. Losartan is an effective antihypertensive agent with an adverse effect profile similar to placebo and a reduced incidence of cough compared to ACE inhibitors.
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