Tolerability and treatment compliance with angiotensin II receptor antagonists

Abstract

Several studies and intervention trials performed during the past 30 years have provided evidence that hypertension-related cardiovascular risk is not irreversible. This is because the reduction in blood pressure (BP) induced by antihypertensive drugs has been shown to be accompanied by a clear-cut decrease in the rate of cardiovascular events and complications. There is also evidence that BP control in the population is far from being optimal, and that no more than one quarter of treated hypertensive patients display BP values <140/90 mm Hg. The reasons for inadequate BP control are multiple, involving a combination of factors such as inadequate compliance with treatment, intolerance to side effects of currently prescribed drugs, and insufficient clinical use of combination drug treatment. This article focuses on three major areas. It first provides an overview of the current status of BP control in treated hypertensive persons. It then examines the factors potentially responsible for this phenomenon, with particular emphasis on the relevance of the so-called "compliance factor." Finally it provides an overview of the tolerability and compliance profile of the angiotensin II receptor antagonists, a new class of antihypertensive drugs characterized by an efficacy and safety profile.

Comparison of the antiproteinuric effects of the calcium channel blockers benidipine and amlodipine administered in combination with angiotensin receptor blockers to hypertensive patients with stage 3–5 chronic kidney disease

“…23,24 Although CCBs and ARBs are considered first-line antihypertensive drugs in Japan, the rate of attaining the target BP level by the administration of monotherapy with either drug is B12-40%. 25,26 According to a Japanese cross-sectional survey, the combination therapy with a CCB and an ARB is the most prescribed treatment for hypertensive patients in Japan. 26 Therefore, physicians frequently prescribe ARBs or ACEIs as first-choice drugs and CCBs as second-choice drugs to hypertensive patients who have CKD with proteinuria.…”

The importance of biological rhythms in drug treatment of hypertension and sex-dependent modifications

“…38,58,[77][78][79][80][81][82][83][84][85][86][87][88][89][90] Drug treatment of hypertension includes various types of drugs, such as diuretics, β-and α-adrenoceptor-blocking drugs, calcium channel blockers, angiotensin-convertingenzyme (ACE) inhibitors, angiotensin II type 1 (AT 1 ) receptor blockers, and others that differ in their sites of action as well as in half-life, galenic formulations, and, thus, in dosing interval. Despite the great number of studies published in evaluating antihypertensive drug efficacy, [91][92][93][94][95][96][97][98][99][100][101][102][103][104] time of day of drug application was only rarely a specific point of investigation. Therefore, in this section, emphasis will be put on crossover studies (morning vs evening) with antihypertensive drugs to highlight this point more clearly.…”

Treatment of hypertension: mono-therapy versus [Zofenopril and Hydrochlorothiazide] combined therapy: A review

“…In addition, the combination therapy Z + HCTZ has been proved able to normalise renal morphological and functional alterations, therefore reducing mortality, in hypertensive rats evaluated in an 8-week, placebo-controlled study [44]. Furthermore, and with respect to the metabolic parameters, no significant difference was observed between pre-treatment and treatment data and between Z as single treatment and the combination Z + HCTZ with respect to total cholesterol, HDL and LDL-cholesterol, triglycerides and glucose plasma concentrations [2,15]. However, the observed tendency of the combined therapy Z + HCTZ to reduce these parameters and in particular triglycerides and HDL -cholesterol may support further the positive influence of such treatment within hypertension conditions.…”

“…Efficacy as well as tolerability is major quality of an antihypertensive drug while the adverse effects associated with treatment are among the most common causes of poor compliance with antihypertensive treatment [1,2]. Therefore, antihypertensive drugs combined with a better tolerability profile can aid compliance and help better the hypertensive population to benefit from experiences in dedicated clinical studies [3].…”