Comparative Effectiveness of Angiotensin II Receptor Blockers in Patients With Hypertension in Japan　― Systematic Review and Network Meta-Analysis ―

Abstract

SBP) >140 mmHg and diastolic BP (DBP) >90 mmHg. 5 According to the JSH, the general target is to reduce SBP/ DBP to <140/90 mmHg, with normal BP classified as <120/80 mmHg. 5 Lifestyle modifications and antihypertensive drug therapy are 2 key approaches for the treatment of hypertension. 5 Lifestyle modifications include dietary changes, such as a reduction in salt intake, weight control, exercise, smoking cessation, and a reduction in alcohol consumption. 5 There are several antihypertensive drug classes that are currently in use, including calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, renin inhibitors, diuretics, and β-blockers. 5 The 2019 JSH guidelines recommend ARBs, CCBs, ACE inhibitors, and low-dose diuretics as first-line treatment for hypertension in Japan. 5 At the time of writing, 7 ARBs were available in Japan: azilsartan, candesartan cilexetil (CAN), irbesartan, losartan potassium (LOS), olmesartan medoxomil (OLM),

Comparative efficacy and safety of fimasartan in patients with hypertension: A network meta‐analysis of randomized controlled trials

“…It presented the highest rank probability at the first rank for sitting DBP, ABPM‐24H SBP, and RR in the 12‐week group. This result was supported by the findings of Nakajima et al 14 . who concluded that azilsartan was more effective than other ARBs for lowering SBP and DBP in Japanese patients.…”

“…Additionally, we analyzed the ABPM data, which could not be explored in preliminary studies due to insufficient data, as shown in Wang et al 11 . and Nakajima et al 14 . We clarified that the best ARB depends on the outcome measure desired by the practitioner and the patient.…”

“…For instance, some new ARBs differ in their chemical structures from existing ones and have better blood pressure control effects in the short term 9,10 . Prior studies also suggested the possibility that the best ARB option may change depending on the prescription and patients’ conditions 11–15 . So far, the selection criteria to choose the best ARB for patients based on comprehensive and scientific comparison is not yet clear.…”

“…Although, some meta‐analysis studies have evaluated existing ARBs via head‐to‐head trials, 11–13 a network meta‐analysis (NMA) comparing all ARBs, including novel agents, is still lacking. Even recent NMA studies of ARBs carried out in Japan 14 and Canada 15 did not include the ninth developed ARB, fimasartan. In addition, since the follow‐up period varied by each clinical trial, most previous meta‐analyses could not avoid heterogeneity issues caused by integrating efficacy results from different time points 11,15–17 .…”

Efficacy of sacubitril/valsartan versus olmesartan in Japanese patients with essential hypertension: a randomized, double-blind, multicenter study

“…Olmesartan is a commonly prescribed angiotensin receptor blocker (ARB) for the management of systolic hypertension among Asians. Moreover, olmesartan was considered the most potent ARB when the current study was designed [ 21 , 22 ], while more recent evidence suggests that olmesartan has safety and efficacy profiles that are similar to those of other ARBs [ 23 – 25 ].…”