April 1, 2000Open Access
View Full PaperAngiotensin II antagonists for hypertension: are there differences in efficacy?
Key Result
Angiotensin II antagonists demonstrated comparable antihypertensive efficacy within the class, with monotherapy reducing systolic BP by 10.4-11.8 mm Hg and diastolic BP by 8.2-8.9 mm Hg.
Study Design
Type
Meta-Analysis (n=11,281)
Structured PICO
Do different angiotensin-II-antagonists have comparable antihypertensive efficacy in patients with hypertension?
P
Population
11,281 patients with hypertension included in a meta-analysis of 43 randomized controlled trials.
I
Intervention
Angiotensin-II-antagonists (losartan, valsartan, irbesartan, candesartan) as monotherapy, dose titration, or combined with low-dose hydrochlorothiazide (HCTZ)
C
Comparator
Placebo, other antihypertensive classes, or direct comparisons between different angiotensin-II-antagonists
O
Outcome
Diastolic and systolic blood pressure reductionsurrogate
Angiotensin-II-antagonists demonstrate comparable antihypertensive efficacy as a class, with a near-flat dose response and substantial potentiation when combined with hydrochlorothiazide.
Abstract
We compared the antihypertensive efficacy of available drugs in the new angiotensin-II-antagonist (AIIA) class. The antihypertensive efficacy of losartan, valsartan, irbesartan, and candesartan was evaluated from randomized controlled trials (RCT) by performing a metaanalysis of 43 published RCT. These trials involved AIIA compared with placebo, other antihypertensive classes, and direct comparisons between AIIA. A weighted-average for diastolic and systolic blood pressure reduction with AIIA monotherapy, dose titration, and with addition of low-dose hydrochlorothiazide (HCTZ) were calculated. Weighted-average responder rates were also determined. The metaanalysis assessed a total of 11,281 patients. The absolute weighted-average reductions in diastolic (8.2 to 8.9 mm Hg) and systolic (10.4 to 11.8 mm Hg) blood pressure reductions (not placebo-corrected) for AIIA monotherapy were comparable for all AIIA. Responder rates for AIIA monotherapy were 48% to 55%. Dose titration resulted in slightly greater blood pressure reduction and an increase in responder rates to 53% to 63%. AIIA/hydrochlorothiazide combinations produced substantially greater reduction in systolic (16.1 to 20.6 mm Hg) and diastolic (9.9 to 13.6 mm Hg) blood pressure reductions than AIIA monotherapy and responder rates for AIIA/HCTZ combinations were 56% to 70%. This comprehensive analysis shows comparable antihypertensive efficacy within the AIIA class, a near-flat AIIA-dose response when titrating from starting to maximum recommended dose, and substantial potentiation of the antihypertensive effect with addition of HCTZ.