Efficacy and safety of angiotensin receptor blockers: A review of losartanin essential hypertension

Background: Current guidelines and results from recent clinical trials have refocused attention on the treatment of hypertension. Emphasis has been pl aced on identifying patients at high risk and treating to lower levels of b lood pressure, particularly in patients with diabetes or target organ damag e. Due to their proven benefits, diuretics and beta-blockers continue to be suggested as initial therapy for patients with essential hypertension. How ever, many acknowledge that antihypertensive therapy needs to be individual ized, taking into account patient demographic characteristics, concomitant diseases that may be affected beneficially or adversely by the antihyperten sive agent chosen, quality of life, cost, and use of other drugs that may l ead to drug interactions. Most patients will require combination therapy to achieve adequate blood pressure control. Therefore, a number of antihypert ensive agents may be appropriate for first-line or add-on therapy. Objective: The objective of this article was to review current treatment op tions for hypertension, with particular emphasis on the angiotensin recepto r blockers (ARBs). Losartan, the most widely studied agent of this class, i s also discussed. Methods: Selected references were sought from MEDLlNE(R) (1990-2000) descri bing the pharmacology antihypertensive efficacy, and tolerability of ARBs. Results: In hypertensive patients, losartan has been compared with other an tihypertensive agents, including enalapril, amlodipine, and nifedipine gast rointestinal therapeutic system. In each case, an antihypertensive regimen of losartan once daily with or without hydrochlorothiazide showed comparabl e blood pressure-lowering effects. Losartan has also consistently demonstra ted an excellent tolerability profile, with an overall incidence of adverse effects similar to that of placebo. Subtle pharmacologic differences exist among the agents of the ARE class. However, a recent meta-analysis suggest ed that no clinically dr statistically significant difference in antihypert ensive efficacy exists among them. Conclusions: ARBs such as losartan are effective with once-daily dosing and have an excellent safety profile. These agents are clearly a useful first- line or add-on treatment option in patients with hypertension.