Angiotensin II receptor antagonists: are they all the same?

Ara-II: Angiotensin II receptor antagonists (ARA-II) belong to a recent cla ss of antihypertensive drugs whose mechanism of action is similar to conver ting enzyme inhibitors (CEI). ARA-II are particularly interesting due to th e excellent clinical and biological tolerance, similar to placebo, and thei r antihypertensive efficacy, comparable with classical drug classes. Published trials: A meta-analysis, published by Conlin in the American Jour nal of Hypertension, suggests that ARA-II, specifically losartan, valsartan , irbesartan and candesartan, have an equipotent blood pressure lowering ef fect. The careful lecture of this meta-analysis however discloses a faulty methodology from which no valid conclusion can be drawn. Since this early p ublication, several other comparative studies have been published. These mu lticentric, randomized double-blind studies enrolled a sufficient number of patients and demonstrated a clinical difference between certain ARA-II at usual dosages. Clinical practice: These studies do have an impact on everyday practice. Fo r the practitioner, the goal is to obtain and then maintain a long-term and optimal reduction in the blood pressure level (reduction or prevention of target-organ disorders and cardiovascular complications of high blood press ure). This reduction in the cardiovascular risk will also depend directly o n tolerance and compliance to the antihypertensive treatment. his element m ust also be considered in assessing treatment efficacy, independent of the blood pressure lowering effect. The results of several other studies will b e published in 2001-2003. These large-scale studies on ARA-II related morbi dity and mortality will be most useful in determining the role of these dru gs in different therapeutic strategies compared with other drug classes.