Efficacy and Duration of Action of the Four Selective Angiotensin II Subtype 1 Receptor Blockers, Losartan, Candesartan, Valsartan and Telmisartan, in Patients with Essential Hypertension Determined by Home Blood Pressure Measurements

Aug 6, 2005Clinical and experimental hypertension (New York, N.Y. : 1993)

Effectiveness and lasting impact of four blood pressure medicines measured at home in people with high blood pressure

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Abstract

The duration of blood pressure-lowering effects varied significantly among the four angiotensin II receptor blockers (ARBs) tested.

Telmisartan demonstrated significantly greater reductions in home systolic and morning diastolic blood pressure compared to losartan.
The morning effect versus evening effect ratios for systolic and diastolic blood pressure were 0.49/0.16 for losartan, 0.69/1.01 for candesartan, 0.82/0.88 for valsartan, and 0.88/0.88 for telmisartan.
Valsartan and telmisartan had a greater lowering effect on home pulse pressure in the morning compared to losartan and candesartan.
Losartan's blood pressure-lowering effect did not persist for 24 hours, while telmisartan and the other ARBs maintained their effects throughout the day.
The duration of the pulse pressure-lowering effect was similar to that of the blood pressure-lowering effect for the ARBs tested.

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Our objective was to compare the efficacy and duration of action of 4 angiotensin II receptor blockers (ARBs)--losartan (25-100 mg), candesartan (2-12 mg), valsartan (40-80 mg), and telmisartan (10-40 mg)-in patients with essential hypertension using self-measurement of blood pressure at home (home BP) and to examine the differential effect of the four ARBs on home pulse pressure (home PP). After a 2-week run-in period, each of the 4 ARBs was assigned to subjects who were diagnosed as having hypertension on the basis of home BP and who were over 30 years old. The subjects were asked to take the ARB once daily in the morning and to measure home BP once in the evening and in the morning. We compared the efficacy of each ARB on home BP and home PP and assessed the duration of the BP-lowering effect using the morning effect versus evening effect ratio (M/E ratio). The antihypertensive effects of telmisartan on home systolic BP (SBP) both in the evening and in the morning and on home diastolic BP (DBP) in the morning were significantly greater than those of losartan. The effect of each ARB on home BP in the morning and in the evening was expressed as a ratio (M/E ratio). The M/E ratios of SBP/DBP in patients treated with losartan, candesartan, valsartan, and telmisartan were 0.49/0.16, 0.69/1.01, 0.82/0.88, and 0.88/0.88, respectively. The home PP-lowering effect was greater for valsartan and telmisartan than for losartan and candesartan in the morning. Among the 4 ARBs, the duration of the BP-lowering effect of losartan did not persist throughout 24 hr. The effects of the other 3 ARBs, in particular telmisartan, persisted over 24 hr when they were administered once daily in the morning. In addition, the duration of the PP-lowering effect was similar to that of the BP-lowering effect. Such long-acting property of several ARBs is essential for the modern antihypertensive treatment, and home BP measurements are useful for determining the duration of action of antihypertensive drugs. Losartan, 25 mg a day, which is usually used as an initial dose in Japan, is apparently insufficient to obtain adequate antihypertensive effect and sufficient duration of action.

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Efficacy and Duration of Action of the Four Selective Angiotensin II Subtype 1 Receptor Blockers, Losartan, Candesartan, Valsartan and Telmisartan, in Patients with Essential Hypertension Determined by Home Blood Pressure Measurements

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