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

Background: Current guidelines and results from recent clinical trials have refocused attention on the treatment of hypertension. Emphasis has been placed on identifying patients at high risk and treating to lower levels of blood pressure, particularly in patients with diabetes or target organ damage. Due to their proven benefits, diuretics and beta-blockers continue to be suggested as initial therapy for patients with essential hypertension. However, many acknowledge that antihypertensive therapy needs to be individualized, taking into account patient demographic characteristics, concomitant diseases that may be affected beneficially or adversely by the antihypertensive agent chosen, quality of life, cost, and use of other drugs that may lead to drug interactions. Most patients will require combination therapy to achieve adequate blood pressure control. Therefore, a number of antihypertensive agents may be appropriate for first-line or add-on therapy. Objective: The objective of this article was to review current treatment options for hypertension, with particular emphasis on the angiotensin receptor blockers (ARBs). Losartan, the most widely studied agent of this class, is also discussed. Methods: Selected references were sought from MEDLlNE(R) (1990-2000) describing the pharmacology antihypertensive efficacy, and tolerability of ARBs. Results: In hypertensive patients, losartan has been compared with other antihypertensive agents, including enalapril, amlodipine, and nifedipine gastrointestinal therapeutic system. In each case, an antihypertensive regimen of losartan once daily with or without hydrochlorothiazide showed comparable blood pressure-lowering effects. Losartan has also consistently demonstrated 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 suggested that no clinically dr statistically significant difference in antihypertensive 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.