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Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertensionHeran BS, Wong MMY, Heran IK, Wright JM
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SummaryAngiotensin receptor blockers for the treatment of elevated blood pressureA class of drugs called angiotensin receptor blockers (ARBs) is commonly used to assist in lowering elevated blood pressure (BP). This class includes drugs such as losartan, candesartan, eprosartan, irbesartan, telmisartan and valsartan. We asked how much this class of drugs lowers BP and whether there is a difference between individual drugs within this class. The available scientific literature was searched to find all the trial evidence to assess this question. Forty six trials that randomly assigned participants to take either an ARB or an inert substance (placebo) were identified. These trials evaluated the BP lowering ability of 9 different ARBs in 13 451 participants who were followed for approximately 7 weeks. No ARB appears to be any better or worse in terms of BP lowering ability and most of the BP lowering effect occurs at the starting doses of these drugs. The best estimate of the average trough BP lowering effect was a modest, –8/-5 mmHg, which is the same as that shown for ACE inhibitors as a class. Due to lack of reporting and the short duration of these trials this review did not provide a good estimate of the harms associated with this class of drugs.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 08. 2008 AbstractBackgroundAngiotensin receptor blockers (ARBs) are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAE). ObjectivesTo quantify the dose-related systolic and/or diastolic BP lowering efficacy of ARBs versus placebo in the treatment of primary hypertension. Search strategyWe searched CENTRAL (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to February 2007), EMBASE (1988 to February 2007) and reference lists of articles. Selection criteriaDouble-blind, randomized, controlled trials evaluating the BP lowering efficacy of fixed-dose monotherapy with an ARB compared with placebo for a duration of 3 to 12 weeks in patients with primary hypertension. Data collection and analysisTwo authors independently assessed trial quality and extracted data. We contacted study authors for additional information. WDAE information was collected from the trials. Main resultsForty six RCTs evaluated the dose-related trough BP lowering efficacy of 9 ARBs in 13 451 participants with a baseline BP of 156/101 mm Hg. The data do not suggest that any one ARB is better or worse at lowering BP. A dose of 1/8 or 1/4 of the manufacturers’ maximum recommended daily dose (Max) achieved a BP lowering effect that was 60 to 70% of the BP lowering effect of Max. A dose of 1/2 Max achieved a BP lowering effect that was 80% of Max. ARB doses above Max did not significantly lower BP more than Max. Due to evidence of publication bias, the largest trials provide the best estimate of the trough BP lowering efficacy for ARBs as a class of drugs: -8 mm Hg for SBP and -5 mm Hg for DBP. ARBs reduced BP measured 1 to 12 hours after the dose by about 12/7 mm Hg. Authors' conclusionsThe evidence from this review suggests that there are no clinically meaningful BP lowering differences between available ARBs. The BP lowering effect of ARBs is modest and similar to ACE inhibitors as a class; the magnitude of average trough BP lowering for ARBs at maximum recommended doses and above is -8/-5 mmHg. Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. The review did not provide a good estimate of the incidence of harms associated with ARBs because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials. |
