Abstract
ARB's inhibit the renin-angiotensin-aldosterone system through antagonism of the AT1 subtype of the angiotensin II receptor. Clinically, these relatively new antihypertensives are thought to serve as useful alternatives to ACE-inhibitors due to a more tolerable side-effect profile. However, the relative antihypertensive efficacy within the class has not been clearly established. Thirteen prospective, head to head studies comparing the antihypertensive efficacy of six ARB's were evaluated. Mean decrease in systolic and diastolic blood pressure, response rate, and discontinuation of drug were compared using meta-analysis methods outlined by D'Agostino and Weintraub.While previous studies demonstrated less favorable efficacy for losartan compared to other ARB’s, this analysis showed no statistically significant differences in any outcome measure tested within the class. From a clinical perspective, these results suggest equivalent antihypertensive efficacy within the ARB class. (See Table) Drug No. of Studies Δ in DBP (mmHg ± SEM) Δ in SBP (mmHg ± SEM) Response Rate (%) DC (%) Candesartan 7 −10.54 ± 0.90 −14.43 ± 1.60 59.1 2.07 Irbesartan 4 −10.38 ± 0.63 −13.30 ± 1.14 62.0 1.40 Losartan 12 −8.86 ± 0.66 −11.63 ± 1.28 54.0 2.46 Olmesartan 1 −11.50 −11.30 NA 1.40 Telmisartan 3 −9.07 ± 0.87 −14.53 ± 1.50 NA 4.20 Valsartan 4 −10.54 ± 0.90 −14.43 ± 1.60 53.8 2.28