Clinical Experience With the Angiotensin II Receptor Antagonist Losartan

The nonpeptide angiotensin II (AII)-receptor antagonist losartan is a selective blocker of the pressor effects of AII. It is now being evaluated as an anti-hypertensive drug in multicenter clinical trials in the United States and other countries. Preliminary inpatient studies have shown that after 5 days of treatment, losartan--in doses of 50, 100, and 150 mg--is significantly more effective than placebo in decreasing blood pressure, and has efficacy similar to that of the angiotensin-converting enzyme (ACE) inhibitor enalapril. Large-scale dose-ranging studies in ambulatory hypertensive patients have shown that 10- and 25-mg losartan doses have brief effects in lowering blood pressure, but when given once daily, 50 mg is the minimal dose needed to produce significant day-long decreases in blood pressure. Interestingly, higher doses do not appear to exhibit greater efficacy; however, the effects of these doses are all similar to those of enalapril (20 mg once daily). Losartan's long duration of action is documented by ratios of trough (end of 24-h dosing interval) to peak antihypertensive effects, which are consistently above 50%. Clinical experiences thus far have indicated a low incidence of adverse events. Preliminary animal and in vitro investigations have shown that losartan produces beneficial effects on cardiac function, renal function, and survival that are similar to those of ACE inhibitors. Additional studies are now under way to define more fully the cardiovascular and metabolic profiles of losartan.