Efficacy of losartan, valsartan, and telmisartan in patients with mild to moderate hypertension

A double-blind, placebo-controlled, crossover study using ambulatory blood pressure monitoring

Roberto Fogari, Amedeo Mugellini, Annalisa Zoppi, Giuseppe Derosa, Andrea Rinaldi, Elena Fogari, Alessandro Vanasia, Paola Preti

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: The angiotensin II (AII) receptor antagonists are effective agents for the treatment of mild to moderate hypertension. Agents within this drug class differ with respect to their pharmacologic and pharmacokinetic properties, which may translate into differences in antihypertensive effect. Objective: The purpose of this study was to compare the antihypertensive efficacy of the AII receptor antagonists losartan, valsartan, and telmisartan using 24-hour ambulatory blood pressure monitoring (ABPM). Methods: Outpatients aged 40 to 60 years with mild to moderate hypertension (sitting diastolic blood pressure [DBP] ≥95 mm Hg and ≤115 mm Hg) were enrolled. After a 4-week placebo washout period, patients were randomized to receive losartan 50 mg, valsartan 80 mg, telmisartan 40 mg, or placebo once daily for 4 weeks according to a 4-period crossover design. Each treatment period was separated by a 2-week placebo washout period. Every 2 weeks, 24-hour ABPM was performed. To assess the homogeneity of blood pressure (BP) control, the trough-to-peak (T/P) ratio and the smoothness index (SI) for systolic blood pressure (SBP) and DBP were calculated. Results: After 2 and 4 weeks of treatment, all 3 agents produced significant reductions in 24-hour, daytime, and nighttime SBP and DBP, compared with placebo (P <0.001). Valsartan, however, induced significantly greater BP reductions than did losartan and telmisartan at 2 weeks (P <0.01) and after 4 weeks (P <0.05) of treatment. At 2 weeks, the T/P ratio was significantly higher with valsartan and telmisartan than with losartan, whereas at 4 weeks all drugs resulted in a T/P ratio >50%. The SI for SBP and DBP was significantly higher with valsartan than with losartan and telmisartan both at 2 weeks (P <0.001) and 4 weeks (P <0.01). A positive correlation between SI for SBP and SI for DBP was found at both 2 and 4 weeks with losartan and valsartan treatments, whereas for telmisartan this correlation was present only at 4 weeks. At 4 weeks, plasma active renin (PAR) levels increased significantly with all drugs compared with placebo (P <0.01 vs placebo), whereas at 2 weeks PAR levels increased significantly (P <0.05 vs placebo) only with losartan and valsartan. Conclusions: In the present study, treatment with valsartan resulted in an earlier, greater, and smoother antihypertensive effect compared with treatment with losartan or telmisartan; this differential effect was likely due to differences in the pharmacologic properties of these agents. Analysis of SI revealed a qualitative difference in the antihypertensive action of telmisartan at the beginning of treatment.

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalCurrent Therapeutic Research
Volume63
Issue number1
DOIs
Publication statusPublished - 2002

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Valsartan
Ambulatory Blood Pressure Monitoring
Losartan
Cross-Over Studies
Placebos
Blood Pressure
Hypertension
Antihypertensive Agents
telmisartan
Angiotensin Receptor Antagonists

Keywords

  • Ambulatory blood pressure monitoring
  • Hypertension
  • Losartan
  • Telmisartan
  • Valsartan

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{5469377edc7845f7ba3ff0a136096f37,
title = "Efficacy of losartan, valsartan, and telmisartan in patients with mild to moderate hypertension: A double-blind, placebo-controlled, crossover study using ambulatory blood pressure monitoring",
abstract = "Background: The angiotensin II (AII) receptor antagonists are effective agents for the treatment of mild to moderate hypertension. Agents within this drug class differ with respect to their pharmacologic and pharmacokinetic properties, which may translate into differences in antihypertensive effect. Objective: The purpose of this study was to compare the antihypertensive efficacy of the AII receptor antagonists losartan, valsartan, and telmisartan using 24-hour ambulatory blood pressure monitoring (ABPM). Methods: Outpatients aged 40 to 60 years with mild to moderate hypertension (sitting diastolic blood pressure [DBP] ≥95 mm Hg and ≤115 mm Hg) were enrolled. After a 4-week placebo washout period, patients were randomized to receive losartan 50 mg, valsartan 80 mg, telmisartan 40 mg, or placebo once daily for 4 weeks according to a 4-period crossover design. Each treatment period was separated by a 2-week placebo washout period. Every 2 weeks, 24-hour ABPM was performed. To assess the homogeneity of blood pressure (BP) control, the trough-to-peak (T/P) ratio and the smoothness index (SI) for systolic blood pressure (SBP) and DBP were calculated. Results: After 2 and 4 weeks of treatment, all 3 agents produced significant reductions in 24-hour, daytime, and nighttime SBP and DBP, compared with placebo (P <0.001). Valsartan, however, induced significantly greater BP reductions than did losartan and telmisartan at 2 weeks (P <0.01) and after 4 weeks (P <0.05) of treatment. At 2 weeks, the T/P ratio was significantly higher with valsartan and telmisartan than with losartan, whereas at 4 weeks all drugs resulted in a T/P ratio >50{\%}. The SI for SBP and DBP was significantly higher with valsartan than with losartan and telmisartan both at 2 weeks (P <0.001) and 4 weeks (P <0.01). A positive correlation between SI for SBP and SI for DBP was found at both 2 and 4 weeks with losartan and valsartan treatments, whereas for telmisartan this correlation was present only at 4 weeks. At 4 weeks, plasma active renin (PAR) levels increased significantly with all drugs compared with placebo (P <0.01 vs placebo), whereas at 2 weeks PAR levels increased significantly (P <0.05 vs placebo) only with losartan and valsartan. Conclusions: In the present study, treatment with valsartan resulted in an earlier, greater, and smoother antihypertensive effect compared with treatment with losartan or telmisartan; this differential effect was likely due to differences in the pharmacologic properties of these agents. Analysis of SI revealed a qualitative difference in the antihypertensive action of telmisartan at the beginning of treatment.",
keywords = "Ambulatory blood pressure monitoring, Hypertension, Losartan, Telmisartan, Valsartan",
author = "Roberto Fogari and Amedeo Mugellini and Annalisa Zoppi and Giuseppe Derosa and Andrea Rinaldi and Elena Fogari and Alessandro Vanasia and Paola Preti",
year = "2002",
doi = "10.1016/S0011-393X(02)80002-9",
language = "English",
volume = "63",
pages = "1--14",
journal = "Current Therapeutic Research - Clinical and Experimental",
issn = "0011-393X",
publisher = "Excerpta Medica",
number = "1",

}

TY - JOUR

T1 - Efficacy of losartan, valsartan, and telmisartan in patients with mild to moderate hypertension

T2 - A double-blind, placebo-controlled, crossover study using ambulatory blood pressure monitoring

AU - Fogari, Roberto

AU - Mugellini, Amedeo

AU - Zoppi, Annalisa

AU - Derosa, Giuseppe

AU - Rinaldi, Andrea

AU - Fogari, Elena

AU - Vanasia, Alessandro

AU - Preti, Paola

PY - 2002

Y1 - 2002

N2 - Background: The angiotensin II (AII) receptor antagonists are effective agents for the treatment of mild to moderate hypertension. Agents within this drug class differ with respect to their pharmacologic and pharmacokinetic properties, which may translate into differences in antihypertensive effect. Objective: The purpose of this study was to compare the antihypertensive efficacy of the AII receptor antagonists losartan, valsartan, and telmisartan using 24-hour ambulatory blood pressure monitoring (ABPM). Methods: Outpatients aged 40 to 60 years with mild to moderate hypertension (sitting diastolic blood pressure [DBP] ≥95 mm Hg and ≤115 mm Hg) were enrolled. After a 4-week placebo washout period, patients were randomized to receive losartan 50 mg, valsartan 80 mg, telmisartan 40 mg, or placebo once daily for 4 weeks according to a 4-period crossover design. Each treatment period was separated by a 2-week placebo washout period. Every 2 weeks, 24-hour ABPM was performed. To assess the homogeneity of blood pressure (BP) control, the trough-to-peak (T/P) ratio and the smoothness index (SI) for systolic blood pressure (SBP) and DBP were calculated. Results: After 2 and 4 weeks of treatment, all 3 agents produced significant reductions in 24-hour, daytime, and nighttime SBP and DBP, compared with placebo (P <0.001). Valsartan, however, induced significantly greater BP reductions than did losartan and telmisartan at 2 weeks (P <0.01) and after 4 weeks (P <0.05) of treatment. At 2 weeks, the T/P ratio was significantly higher with valsartan and telmisartan than with losartan, whereas at 4 weeks all drugs resulted in a T/P ratio >50%. The SI for SBP and DBP was significantly higher with valsartan than with losartan and telmisartan both at 2 weeks (P <0.001) and 4 weeks (P <0.01). A positive correlation between SI for SBP and SI for DBP was found at both 2 and 4 weeks with losartan and valsartan treatments, whereas for telmisartan this correlation was present only at 4 weeks. At 4 weeks, plasma active renin (PAR) levels increased significantly with all drugs compared with placebo (P <0.01 vs placebo), whereas at 2 weeks PAR levels increased significantly (P <0.05 vs placebo) only with losartan and valsartan. Conclusions: In the present study, treatment with valsartan resulted in an earlier, greater, and smoother antihypertensive effect compared with treatment with losartan or telmisartan; this differential effect was likely due to differences in the pharmacologic properties of these agents. Analysis of SI revealed a qualitative difference in the antihypertensive action of telmisartan at the beginning of treatment.

AB - Background: The angiotensin II (AII) receptor antagonists are effective agents for the treatment of mild to moderate hypertension. Agents within this drug class differ with respect to their pharmacologic and pharmacokinetic properties, which may translate into differences in antihypertensive effect. Objective: The purpose of this study was to compare the antihypertensive efficacy of the AII receptor antagonists losartan, valsartan, and telmisartan using 24-hour ambulatory blood pressure monitoring (ABPM). Methods: Outpatients aged 40 to 60 years with mild to moderate hypertension (sitting diastolic blood pressure [DBP] ≥95 mm Hg and ≤115 mm Hg) were enrolled. After a 4-week placebo washout period, patients were randomized to receive losartan 50 mg, valsartan 80 mg, telmisartan 40 mg, or placebo once daily for 4 weeks according to a 4-period crossover design. Each treatment period was separated by a 2-week placebo washout period. Every 2 weeks, 24-hour ABPM was performed. To assess the homogeneity of blood pressure (BP) control, the trough-to-peak (T/P) ratio and the smoothness index (SI) for systolic blood pressure (SBP) and DBP were calculated. Results: After 2 and 4 weeks of treatment, all 3 agents produced significant reductions in 24-hour, daytime, and nighttime SBP and DBP, compared with placebo (P <0.001). Valsartan, however, induced significantly greater BP reductions than did losartan and telmisartan at 2 weeks (P <0.01) and after 4 weeks (P <0.05) of treatment. At 2 weeks, the T/P ratio was significantly higher with valsartan and telmisartan than with losartan, whereas at 4 weeks all drugs resulted in a T/P ratio >50%. The SI for SBP and DBP was significantly higher with valsartan than with losartan and telmisartan both at 2 weeks (P <0.001) and 4 weeks (P <0.01). A positive correlation between SI for SBP and SI for DBP was found at both 2 and 4 weeks with losartan and valsartan treatments, whereas for telmisartan this correlation was present only at 4 weeks. At 4 weeks, plasma active renin (PAR) levels increased significantly with all drugs compared with placebo (P <0.01 vs placebo), whereas at 2 weeks PAR levels increased significantly (P <0.05 vs placebo) only with losartan and valsartan. Conclusions: In the present study, treatment with valsartan resulted in an earlier, greater, and smoother antihypertensive effect compared with treatment with losartan or telmisartan; this differential effect was likely due to differences in the pharmacologic properties of these agents. Analysis of SI revealed a qualitative difference in the antihypertensive action of telmisartan at the beginning of treatment.

KW - Ambulatory blood pressure monitoring

KW - Hypertension

KW - Losartan

KW - Telmisartan

KW - Valsartan

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U2 - 10.1016/S0011-393X(02)80002-9

DO - 10.1016/S0011-393X(02)80002-9

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JO - Current Therapeutic Research - Clinical and Experimental

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