Dose-Related Efficacy of Irbesartan for Hypertension

Abstract

Abstract-Results of eight multicenter, randomized, placebo-controlled, double-blind, parallel-group studies were pooled to assess the efficacy of the angiotensin II-receptor blocker irbesartan over the dose range of 1 to 900 mg. A total of 2955 adults with a seated diastolic blood pressure of 95 to 110 mm Hg were randomized to treatment with oral irbesartan once daily or placebo for 6 to 8 weeks. Office blood pressure was measured at trough (24Ϯ3 hours after the last dose) and peak (3Ϯ1 hours after the last dose) by mercury sphygmomanometry. Demographic characteristics (mean blood pressure; 151/101 mm Hg; mean age, 54 years; 63% male; and 82% white) were similar across all dose groups. After the groups were pooled, antihypertensive efficacy was assessed by therapeutic response (trough seated diastolic blood pressure Ͻ90 mm Hg or a reduction from baseline of Ն10 mm Hg) and by modeling of the maximum reductions in trough and peak seated diastolic and systolic blood pressure. Antihypertensive effects increased with increasing doses and reached a plateau at Ն300 mg. Irbesartan 150 mg provided placebo-subtracted reductions in trough seated systolic and diastolic blood pressure of Ϸ8 and Ϸ5 mm Hg, respectively, with 56% of patients displaying a favorable response.In conclusion, irbesartan provides clinically significant blood pressure lowering, with a clear relationship between (log) dose and antihypertensive effect. (Hypertension. 1998;31:1311-1316.)

AT1-receptor blockers: differences that matter

“…For example, six randomised, placebo-controlled, parallel-group dose-response studies, involving a total of 1482 patients, have investigated the antihyperten-sive efficacy of candesartan cilexetil (the prodrug of candesartan) in patients with essential hypertension. A meta-analysis of these studies 20 showed that the placebo-corrected mean reductions in sitting diastolic blood pressure were approximately 4.5 mm Hg with 4 mg, 6 mm Hg with 8 21 Similarly, a meta-analysis of nine studies with valsartan, involving 4117 patients, showed mean reductions in diastolic blood pressure of between 2.5 mm Hg and 5.1 mm Hg at doses of 40-160 mg. 22 A recent meta-analysis has compared the doseresponse relationships for candesartan, irbesartan, valsartan and losartan. 23 The analysis included all double-blind, placebo-controlled, fixed dose, parallel-group studies, with a duration of 4 weeks or longer, in patients with mild-to-moderate hypertension, that had been submitted to the US Food and Drug Administration (FDA).…”

Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension

“…The administration of up to 600 mg irbesartan was safe, as it has been previously shown in other studies. 21 This study's defined alarm criteria/algorithms proved to be practicable. A good correlation between morning TBPM readings and the mean 24-h BP at month 3 could be shown.…”

“…[18][19][20][21][22] Both groups were instructed to measure their home BP once daily. The standard care group were advised to contact the treating physician by phone or visit the office in case of side effects or a not sufficient BP reduction.…”

Putting the efficacy of candesartan cilexetil into perspective: a review of new comparative data

“…The placebo-corrected blood pressure reductions were not affected by age, gender or baseline blood pressure. 36 Other AIIRAs, valsartan, irbesartan and telmisartan, have also shown dose-response curves [37][38][39] but losartan, by contrast, displays a flat dose-response. 40 …”