Management of arterial hypertension with angiotensin receptor blockers: Current evidence and the role of olmesartan

Abstract

Summary Elevated blood pressure (BP) is a major determinant of morbidity and mortality burden related to cardio‐metabolic risk. Current guidelines indicate that controlling and lowering BP promotes cardiovascular (CV) risk reduction. Among antihypertensive agents, angiotensin receptor blockers (ARBs) are characterized by an efficacy profile equivalent to other antihypertensive agents and are provided with excellent tolerability and low discontinuation rates during chronic treatments. Moreover, CV outcomes are reduced by ARBs. Olmesartan is a long‐lasting ARB which proved to achieve a comparable or more effective action in lowering BP when compared to other ARBs. Olmesartan, in fact, displayed a larger and more sustained antihypertensive effect over the 24 hours, with a buffering effect on short‐term BP variability. These are important features which differentiate olmesartan from the other principles of the same class and that may help to control the increased CV risk in the presence of high BP variability. Olmesartan shows similar benefits as other ARBs in terms of all‐cause and CV mortality, and a favorable tolerability profile. Combination of olmesartan with long‐lasting calcium‐channel blockers and thiazide diuretics represents a rational and effective therapy. Thus, ARBs, including olmesartan, represent one of the most effective and safe treatments for patients with arterial hypertension.

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“…Olmesartan was originally developed by Daiichi-Sanyo and approved by the U.S Food and Drug Administration (FDA) in April of 2002 for the treatment of hypertension. In August 2006, Olmesartan was approved for marketing in China under the trade name Olrnetec [ 10 , 11 ]. Olmesartan exerts vasoconstriction and reduction of aldosterone secretion by specifically blocking angiotensin II and binding to the angiotensin 1 receptor located on vascular smooth muscles to suppress the production of renin [ 12 ].…”

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“…The major drug classes available for the management of hypertension are thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor II blockers, and calcium channel blockers (Susalit et al, 2011;Munoz-Durango et al, 2016). Vasodilators, aldosterone antagonists, b-blockers, a-blockers, renin inhibitors, and central-acting agents are other agents that are occasionally used (Omboni and Volpe, 2018). These agents lower BP in patients and reduce their risk of hypertension-related CVD events, but do not prevent them thereby justifying the use of hypertension combination therapies (Rizvi, 2017).…”

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“…ARBs have been available for the clinical management of hypertension and hypertension-related CV diseases since 1995. Within this antihypertensive drug class, OLM is one of the agents characterized by long-lasting efficacy and a documented profile of tolerability and safety [26,27]. Indeed, the higher efficacy of OLM compared to other ARBs, proved also by the persistent BP reductions over the 24-h BP period, confers to OLM additional therapeutic benefits [28].…”