Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis
Abstract Angiotensin‐receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin‐receptor blockers may be more effective than the older ones. A network meta‐analysis was performed to compare the efficacy of various angiotensin‐receptor blo...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-05-01
|
| Series: | The Journal of Clinical Hypertension |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jch.14227 |
| _version_ | 1797645150600560640 |
|---|---|
| author | Ji‐Guang Wang Miao Zhang Ying‐Qing Feng Chang‐Sheng Ma Tzung‐Dau Wang Zhi‐Ming Zhu Kazuomi Kario |
| author_facet | Ji‐Guang Wang Miao Zhang Ying‐Qing Feng Chang‐Sheng Ma Tzung‐Dau Wang Zhi‐Ming Zhu Kazuomi Kario |
| author_sort | Ji‐Guang Wang |
| collection | DOAJ |
| description | Abstract Angiotensin‐receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin‐receptor blockers may be more effective than the older ones. A network meta‐analysis was performed to compare the efficacy of various angiotensin‐receptor blockers in reducing office and ambulatory blood pressure in hypertensive patients. Relevant literature was searched from English and Chinese databases for randomized controlled trials involving angiotensin‐receptor blockers in hypertension. Efficacy variables included systolic and diastolic blood pressure either in the office or on ambulatory blood pressure monitoring. Absolute blood pressure reductions at 6‐12 weeks of treatment and their credible intervals were reported. A total of 34 publications provided adequate data for analysis (n = 14 859). In 28 studies on office systolic blood pressure (n = 12 731), against the common comparator valsartan 80 mg, the differences in systolic blood pressure were in favor of azilsartan medoxomil (20‐80 mg), irbesartan (300 mg), olmesartan (20‐40 mg), telmisartan (80 mg), and valsartan (160‐320 mg), but not candesartan (8‐16 mg), losartan (50‐100 mg), irbesartan (150 mg), olmesartan (10 mg), and telmisartan (40 mg). The ranking plot shows that azilsartan medoxomil 80 mg had a possibility of 99% being the best in the class. Similar results were observed for office diastolic blood pressure and from 13 studies for 24‐hour ambulatory systolic and diastolic blood pressure. In conclusion, angiotensin‐receptor blockers had different blood pressure lowering efficacy. The newest angiotensin‐receptor blocker azilsartan medoxomil at the dose of 80 mg seemed to be most efficacious in reducing both systolic and diastolic blood pressure in the office and on ambulatory measurement. |
| first_indexed | 2024-03-11T14:41:58Z |
| format | Article |
| id | doaj.art-3c378fdfbd82488a9b904cf5e832b858 |
| institution | Directory Open Access Journal |
| issn | 1524-6175 1751-7176 |
| language | English |
| last_indexed | 2024-03-11T14:41:58Z |
| publishDate | 2021-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Journal of Clinical Hypertension |
| spelling | doaj.art-3c378fdfbd82488a9b904cf5e832b8582023-10-30T13:30:30ZengWileyThe Journal of Clinical Hypertension1524-61751751-71762021-05-0123590191410.1111/jch.14227Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysisJi‐Guang Wang0Miao Zhang1Ying‐Qing Feng2Chang‐Sheng Ma3Tzung‐Dau Wang4Zhi‐Ming Zhu5Kazuomi Kario6The Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of Medicine Shanghai ChinaMedical Affairs Takeda Pharmaceuticals Ltd Shanghai ChinaGuangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou ChinaDepartment of Cardiology Beijing Anzhen Hospital Beijing ChinaCardiovascular Center and Divisions of Hospital Medicine and Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei City TaiwanChongqing Hypertension Institute Department of Hypertension and Endocrinology Daping Hospital The Third Military Medical University Chongqing ChinaDivision of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi JapanAbstract Angiotensin‐receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin‐receptor blockers may be more effective than the older ones. A network meta‐analysis was performed to compare the efficacy of various angiotensin‐receptor blockers in reducing office and ambulatory blood pressure in hypertensive patients. Relevant literature was searched from English and Chinese databases for randomized controlled trials involving angiotensin‐receptor blockers in hypertension. Efficacy variables included systolic and diastolic blood pressure either in the office or on ambulatory blood pressure monitoring. Absolute blood pressure reductions at 6‐12 weeks of treatment and their credible intervals were reported. A total of 34 publications provided adequate data for analysis (n = 14 859). In 28 studies on office systolic blood pressure (n = 12 731), against the common comparator valsartan 80 mg, the differences in systolic blood pressure were in favor of azilsartan medoxomil (20‐80 mg), irbesartan (300 mg), olmesartan (20‐40 mg), telmisartan (80 mg), and valsartan (160‐320 mg), but not candesartan (8‐16 mg), losartan (50‐100 mg), irbesartan (150 mg), olmesartan (10 mg), and telmisartan (40 mg). The ranking plot shows that azilsartan medoxomil 80 mg had a possibility of 99% being the best in the class. Similar results were observed for office diastolic blood pressure and from 13 studies for 24‐hour ambulatory systolic and diastolic blood pressure. In conclusion, angiotensin‐receptor blockers had different blood pressure lowering efficacy. The newest angiotensin‐receptor blocker azilsartan medoxomil at the dose of 80 mg seemed to be most efficacious in reducing both systolic and diastolic blood pressure in the office and on ambulatory measurement.https://doi.org/10.1111/jch.14227ambulatoryangiotensin‐receptor blockerblood pressureefficacynetwork meta‐analysissystematic review |
| spellingShingle | Ji‐Guang Wang Miao Zhang Ying‐Qing Feng Chang‐Sheng Ma Tzung‐Dau Wang Zhi‐Ming Zhu Kazuomi Kario Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis The Journal of Clinical Hypertension ambulatory angiotensin‐receptor blocker blood pressure efficacy network meta‐analysis systematic review |
| title | Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis |
| title_full | Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis |
| title_fullStr | Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis |
| title_full_unstemmed | Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis |
| title_short | Is the newest angiotensin‐receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta‐analysis |
| title_sort | is the newest angiotensin receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones a systematic review and network meta analysis |
| topic | ambulatory angiotensin‐receptor blocker blood pressure efficacy network meta‐analysis systematic review |
| url | https://doi.org/10.1111/jch.14227 |
| work_keys_str_mv | AT jiguangwang isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT miaozhang isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT yingqingfeng isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT changshengma isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT tzungdauwang isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT zhimingzhu isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis AT kazuomikario isthenewestangiotensinreceptorblockerazilsartanmedoxomilmoreefficaciousinloweringbloodpressurethantheolderonesasystematicreviewandnetworkmetaanalysis |