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Angiotensin Receptor Blockers for Management of

Daniel F. Catanzaro, PhD, MBA, William H. Frishman, MD
South Med J. 2010;103(7):669-673.
Use of ARBs for Hypertension: Current Treatment Guidelines

Seven ARBs are currently approved for use in the United States:
candesartan, eprosartan, irbesartan, losartan, olmesartan,
telmisartan, and valsartan ( Table 1).
Several national and international guidelines have been
promulgated for the management of hypertension ( Table 2). All
of these guidelines recognize ARBs as a major addition to the
therapeutic armamentarium for the treatment of hypertension.
Together, these guidelines highlight an important role for ARBs in
the treatment of patients who cannot tolerate ACEI therapy and
as an important option in the treatment of patients with
concurrent disorders such as heart failure and type 2 diabetes.
ARB Tolerability in Hypertension
Generally, ARBs and ACEIs are well tolerated. However, there are
potentially clinically relevant disparities in the safety profiles of
these agents. In a meta-analysis of clinical studies published
between 1966 and 2006 that directly compared the effects of
ARBs and ACEIs, researchers found no differences between these
agents in the overall rate of adverse events or in the incidence of
commonly reported adverse events such as headache and
dizziness. [32] However, the mean incidence of cough across
studies was notably higher among ACEI-treated patients than
among ARB-treated patients (10% vs 3%). Moreover,
angioedema, a potentially life-threatening adverse event, was
rarely reported in the studies, but all reported cases occurred
with ACEI treatment. This analysis also revealed that withdrawals
due to adverse events tended to occur more frequently with ACEI
than with ARB therapy (8% vs 4%).

A separate study, based on a review of literature from 1995 to 2008, examined

treatment persistence with the major classes of drugs used to treat hypertension.
[33] The results showed that, over a 12-month period, persistence with
treatment was generally higher with ARBs, compared with ACEIs, CCBs, beta-
blockers, or diuretics. For ARBs, 12-month persistence with treatment ranged
from 42% to 64%. The authors concluded that a combination of clinical efficacy,
tolerability, and persistence with treatment renders ARBs an attractive
alternative for the long-term management of hypertension. Although the authors
did not examine the reasons for the favorable rate of treatment persistence with
ARB therapy, it seems plausible to assume a relatively favorable safety profile
may be a major contributing factor.