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Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan

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Abstract

The efficacy and safety of Iosartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg (n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure (SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24hour ABPM were also significant with the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval. The anti hypertensive response rate was 54% with losartan and 46% with valsartan. Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients. Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average 0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar anti hypertensive effects in patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists.

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Authors and Affiliations

  1. Hospital San Juan de Dios, Ciudad, Guatemala

    Victor H. Monterroso M.D.

  2. Clinica Maison de Sante, Hospital FAP Comandante J. B. Doric, Lima, Peru

    Victor Rodriguez Chavez M.D.

  3. Hospital Regional Espanol, Buenos Aires, Argentina

    Evert T. Carbajal & Daniel R. Vogel M.D.

  4. Clinica Renal de la Costa, Barranquilla, Colombia

    Gustavo J. Aroca Martinez M.D.

  5. Hosital Universitario San Jorge, Pereira, Colombia

    Luis H. Garcia M.D.

  6. Morones Prieto, Monterrey, Mexico

    Jorge H. B. Cuevas M.D.

  7. Panamerican Clinic, Guayaquil, Ecuador

    Joffre LaraTeran M.D.

  8. Society for Clinical Pharmacology, Vienna, Austria

    Gerhart Hitzenberger M.D.

  9. Hospital de Faro, Faro, Portugal

    Pedro Leao Neves M.D.

  10. Johannesburg General Hospital, Parktown, South Africa

    Shirley J. Middlemost M.D.

  11. MSD-CBARDS, Brussels, Belgium

    Thomas Dumortier

  12. Merck & Co., Inc., One Merck Drive, PO Box 100 WS3C-50, 08889-0100, Whitehouse Station, NJ, USA

    Antonius M. G. Bunt M.D. & Ronald D. Smith Ph.D. for the Losartan Trial Investigators

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  1. Victor H. Monterroso M.D.
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  2. Victor Rodriguez Chavez M.D.
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  3. Evert T. Carbajal
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  4. Daniel R. Vogel M.D.
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  6. Luis H. Garcia M.D.
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  7. Jorge H. B. Cuevas M.D.
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  8. Joffre LaraTeran M.D.
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  9. Gerhart Hitzenberger M.D.
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  10. Pedro Leao Neves M.D.
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  11. Shirley J. Middlemost M.D.
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  12. Thomas Dumortier
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  13. Antonius M. G. Bunt M.D.
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  14. Ronald D. Smith Ph.D. for the Losartan Trial Investigators
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Monterroso, V.H., Chavez, V.R., Carbajal, E.T. et al. Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan. Adv Therapy 17, 117–131 (2000). https://doi.org/10.1007/BF02854844

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  • DOI: https://doi.org/10.1007/BF02854844

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