Angiotensin II receptor blockers

Blocking the action of angiotensin II reduces vasoconstriction, the retention of sodium and water, sympathetic nervous system activation, and constriction of blood vessels in the kidneys.2 The result is a decrease in blood pressure, a reduction in protein loss from the kidneys, and a reduction in left ventricular hypertrophy (a thickening of the left ventricular muscle wall).3,4 Approximately 27% [...] Systematic reviews and meta-analyses One meta-analysis was identified that compared telmisartan to losartan in titration-to-response studies.10 The objective of the meta-analysis was to compare the ability of the two ARB’s to reduce blood pressure during the last six hours of a 24-hour dosing interval. [...] In the telmisartan and losartan groups, the average ages were 53.2 and 54.4 years old, respectively, and in both groups the majority of patients were male. [...] In terms of efficacy, the average mean reduction in blood pressure during the last six hours of the dosing interval (measured with 24 hour ABPM) was significantly greater (p<0.01) in the telmisartan group (6.6 ± 0.4 mmHg) than the losartan group (5.1 mmHg. [...] It should be noted that the product monograph for losartan recommends twice daily dosing or increasing the dose in those individuals whose blood pressure control is not maintained at the end of the dosing interval.9 As well, the methodology of the meta-analysis was not described in sufficient detail to assess how rigorous it was.