Angiotensin II antagonists for hypertension: Are there differences in efficacy?

We compared the antihypertensive efficacy of available drugs in the new ang iotensin-II-antagonist (AIIA) class. The antihypertensive efficacy of losar tan, valsartan, irbesartan, and candesartan was evaluated from randomized c ontrolled trials (RCT) by performing a metaanalysis of 43 published RCT. Th ese trials involved AIIA compared with placebo, other antihypertensive clas ses, and direct comparisons between AIIA. A weighted-average for diastolic and systolic blood pressure reduction with AIIA monotherapy, dose titration , and with addition of low-dose hydrochlorothiazide (HCTZ) were calculated. Weighted-average responder rates were also determined. The metaanalysis as sessed a total of 11,281 patients. The absolute weighted-average reductions in diastolic (8.2 to 8.9 mm Hg) and systolic (10.4 to 11.8 mm Hg) blood pr essure reductions (not placebo-corrected) for AIIA monotherapy were compara ble for all AIIA. Responder rates for AIIA monotherapy were 48% to 55%. Dos e titration resulted in slightly greater blood pressure reduction and an in crease in responder rates to 53% to 63%. AIIA/hydrochlorothiazide combinati ons produced substantially greater reduction in systolic (16.1 to 20.6 mm H g) and diastolic (9.9 to 13.6 mm Hg) blood pressure reductions than AIIA mo notherapy and responder rates for AIIA/HCTZ combinations were 56% to 70%. T his comprehensive analysis shows comparable antihypertensive efficacy withi n the AIIA class, a near-flat AIIA-dose response when titrating from starti ng to maximum recommended dose, and substantial potentiation of the antihyp ertensive effect with addition of HCTZ. (C) 2000 American Journal of Hypert ension, Ltd.