Comparing the therapeutic merits of angiotensin receptor blockers

Abstract

See original paper on page 1218 S uccessful control of blood pressure (BP) remains suboptimal in many jurisdictions [1]. Although there are many reasons for this, the considerable prevalence of hypertension is a challenge [2]. More than one quarter of adults in Western populations have high BP. In addition to being the leading attributable risk factor for death throughout the world, hypertension results in substantial illness due to its effect on several target organs, including the brain, eyes, heart, arteries, and kidneys [3][4][5][6]. It is the most common reason for a consultation at primary care level in which the majority of its management takes place. In addition to nonpharmacologic interventions, most individuals require antihypertensive medication to lower BP and often require them in combination. An understanding of the mode of action and complementary features of differing BP medications is important. The greater use of 'out of office' measurements highlights the need to use medications that offer good 24-h BP control and possibly have a complementary effect on indices, such as BP variability and the morning surge [7-10].Although lifestyle modification is important in hypertension management, most hypertensive individuals require more than two antihypertensive drugs to reduce their BP and maintain it within acceptable ranges [11][12][13]. The effectiveness of at least five classes of drugs used in treating hypertension and preventing cardiovascular events is well documented [12]. Yet there are differences in the therapeutic characteristics of medications within BP lowering classes [14]. The most commonly used medications among the many choices in antihypertensive therapy are those aimed at inhibiting the renin-angiotensin-aldosterone system.In this issue of Journal of Hypertension, there is an interesting article from Satoh and colleagues [15] evaluating a number of therapeutic characteristics of AT1 blockers, including 'velocity of maximal effect' or stabilization time, by which is meant the time interval from starting the medication to when it has its maximal effect. While the authors have described this time index previously, in this article, they evaluate seven different AT1 blockers, all used at medium dosage as monotherapy in patients referred to a specialist clinic for hypertension [16,17]. The drugs were compared in relation to the magnitude of the BP-lowering effect and the rapidity with which this maximum effect was achieved. The velocity or stabilization time based on morning home-BP readings differed significantly within the drug class. The magnitude of effect also varied, and Fig. 2 in Satoh et al. [15] might assist clinicians in their medication selection and follow-up of patients. The extent of BP-lowering effects of azilsartan was significantly greater than that of valsartan or irbesartan. The stabilization time of losartan based on home-SBP was significantly longer than that of azilsartan, valsartan, or irbesartan [15]. The authors suggest that clinicians should be aware of these varyi...