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Comparison of ARBs Angiotensin Receptor Blockers
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The ARBs have very comparable scientific profiles. They do, however, have different
pharmacokinetic profiles, which can lead to some differences in efficacy. The newer products
irbesartan, candesartan, telmisartan, and olmesartan have longer half-lives and duration of action
than the older products losartan and valsartan. Twenty-four-hour blood pressure control could
possibly be more readily achievable with the newer agents. Losartan and valsartan may need to be
administered twice every day in sufferers needing better antihypertensive effects, whereas the
agents with longer durations of action have no additional advantage when administered more than
once daily. Of course, single dose product is at all times preferred.
Several double-blind, head-to-head comparative trials have evaluated the relative antihypertensive
efficacy of the ARBs in sufferers with mild to moderate hypertension. The result is that the
longer-appearing products may be more effective than losartan and valsartan at offering 24-hour
blood pressure control. However a metaanalysis of 43 trials comparing the antihypertensive effects
of ARBs found comparable antihypertensive efficacies inside the ARB class. Whether or not reported
differences in efficacy are clinically related regarding morbidity and mortality has not been
determined.
There are currently seven drugs on the market that are angiotensin II inhibitors. The table
below shows characteristics of each of them and may be helpful for your MD in selecting the best
one for your situation
Chemical Name |
Losartan |
Olmesartan |
Valsartan |
Irbesartan |
Candesartan |
Telmisartan |
Eprosartan |
Brand Name |
Cozaar |
Benicar |
Diovan, Novartis |
Avapro,Squibb |
Antacad |
Micardis |
Teveten |
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Introduced |
1995 |
2002 |
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|
BP Drop
|
8/5.5
|
12.5/11.5
|
7.5/4.0
|
10/6.5
|
10/6
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9.5/6
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7.5/4.5
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Affinity for the AT2 receptor
|
1,000 |
12,500 |
20,000 |
8,500 |
10,000 |
3,000 |
1,000 |
Half Life
|
6-9 hrs
|
13 hrs
|
6 hrs
|
11-15 hrs
|
9 hrs
|
24 hrs
|
5-9 hrs
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P450 enzymes
affinity
|
HIGH |
None |
None |
HIGH |
Modest |
None |
None |
Known interactions |
ketoconazole,
troleandomycin,
cimetidine,
Rifampin |
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digoxin |
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Crosses Blood Brain Barrier
|
No |
No |
No |
No |
Yes |
Yes |
No |
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