Efficacy and duration of action of the four selective angiotensin II subtype 1 receptor blockers, losartan, candesartan, valsartan and telmisartan, in patients with essential hypertension determined by home blood pressure measurements
Efficacy and duration of action of the four selective angiotensin II subtype 1 receptor blockers, losartan, candesartan, valsartan and telmisartan, in patients with essential hypertension determined by home blood pressure measurements
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DOI：
10.1081/ceh-200067668
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发表时间：
2005-08-01
影响因子：
12.3
通讯作者：
Imai, Y
中科院分区：
文献类型：
--
作者：
Nishimura, T;Hashimoto, J;Imai, Y
我们的目的是比较4种血管紧张素H受体阻滞剂（ARB）-氯沙坦的疗效和作用时间（25-100 mg）、坎地沙坦（2-12 mg）、缬沙坦（40-80 mg），和替米沙坦（10-40 mg）-在原发性高血压患者中使用在家自我测量血压（在家BP）并检查四种ARB对家庭脉压（家庭PP）的不同影响。2周导入期后，将4种ARB分别分配给根据家庭BP诊断为高血压且年龄超过30岁的受试者。要求受试者每天早晨服用一次ARB，并在晚上和早晨测量一次家庭血压。我们比较了每种ARB对家庭BP和家庭PP的疗效，并使用早晨效应与晚上效应比（M/E比）评估了BP降低效应的持续时间。替米沙坦对夜间和早晨家庭收缩压（SBP）和早晨家庭舒张压（DBP）的降压作用均显著大于氯沙坦。每种ARB对早晨和晚上家庭血压的影响表示为比率（MIE比率）。氯沙坦、坎地沙坦、缬沙坦和替米沙坦治疗患者的SBP/DBP MIE比值分别为0.49/0.16、0.69/1.01、0.82/0.88和0.88/0.88。在早晨，缬沙坦和替米沙坦的家庭PP降低效应大于氯沙坦和坎地沙坦。在4种ARB中，氯沙坦的降压作用持续时间不超过24小时。其他3种ARB，特别是替米沙坦，在早晨每天给药一次时，降压作用持续时间超过24小时。此外，降低PP效应的持续时间与降低BP效应的持续时间相似。几种ARB的这种长效特性对于现代抗高血压治疗是必不可少的，并且家庭血压测量对于确定抗高血压药物的作用持续时间是有用的。氯沙坦，25 mg/天，通常在日本用作初始剂量，显然不足以获得足够的抗高血压作用和足够的作用持续时间。
Our objective was to compare the efficacy and duration of action of 4 angiotensin H receptor blockers (ARBs)-losartan (25-100 mg), candesartan (2-12 mg), valsartan (40-80 mg), and telmisartan (10-40 mg)-in patients with essential hypertension using self-measurement of blood pressure at home (home BP) and to examine the differential effect of the four ARBs on home pulse pressure (home PP). After a 2-week run-in period, each of the 4 ARBs was assigned to subjects who were diagnosed as having hypertension on the basis of home BP and who were over 30 years old. The subjects were asked to take the ARB once daily in the morning and to measure home BP once in the evening and in the morning. We compared the efficacy of each ARB on home BP and home PP and assessed the duration of the BP-lowering effect using the morning effect versus evening effect ratio (M/E ratio). The antihypertensive effects of telmisartan on home systolic BP (SBP) both in the evening and in the morning and on home diastolic BP (DBP) in the morning were significantly greater than those of losartan. The effect of each ARB on home BP in the morning and in the evening was expressed as a ratio (MIE ratio). The MIE ratios of SBP/DBP in patients treated with losartan, candesartan, valsartan, and telmisartan were 0.49/0.16, 0.69/1.01, 0.82/0.88, and 0.88/0.88, respectively. The home PP-lowering effect was greater for valsartan and telmisartan than for losartan and candesartan in the morning. Among the 4 ARBs, the duration of the BP-lowering effect of losartan did not persist throughout 24 hr. The effects of the other 3 ARBs, in particular telmisartan, persisted over 24 hr when they were administered once daily in the morning. In addition, the duration of the PP-lowering effect was similar to that of the BP-lowering effect. Such long-acting property of several ARBs is essential for the modem antihypertensive treatment, and home BP measurements are useful for determining the duration of action of antihypertensive drugs. Losartan, 25 mg a day, which is usually used as an initial dose in Japan, is apparently insufficient to obtain adequate antihypertensive effect and sufficient duration of action.