The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Medical Affairs, Takeda Pharmaceuticals Ltd, Shanghai, China.
J Clin Hypertens (Greenwich). 2021 May;23(5):901-914. doi: 10.1111/jch.14227. Epub 2021 Feb 20.
Angiotensin-receptor blockers are often considered insufficiently efficacious in reducing blood pressure. However, newer angiotensin-receptor blockers may be more effective than the older ones. A network meta-analysis was performed to compare the efficacy of various angiotensin-receptor blockers in reducing office and ambulatory blood pressure in hypertensive patients. Relevant literature was searched from English and Chinese databases for randomized controlled trials involving angiotensin-receptor blockers in hypertension. Efficacy variables included systolic and diastolic blood pressure either in the office or on ambulatory blood pressure monitoring. Absolute blood pressure reductions at 6-12 weeks of treatment and their credible intervals were reported. A total of 34 publications provided adequate data for analysis (n = 14 859). In 28 studies on office systolic blood pressure (n = 12 731), against the common comparator valsartan 80 mg, the differences in systolic blood pressure were in favor of azilsartan medoxomil (20-80 mg), irbesartan (300 mg), olmesartan (20-40 mg), telmisartan (80 mg), and valsartan (160-320 mg), but not candesartan (8-16 mg), losartan (50-100 mg), irbesartan (150 mg), olmesartan (10 mg), and telmisartan (40 mg). The ranking plot shows that azilsartan medoxomil 80 mg had a possibility of 99% being the best in the class. Similar results were observed for office diastolic blood pressure and from 13 studies for 24-hour ambulatory systolic and diastolic blood pressure. In conclusion, angiotensin-receptor blockers had different blood pressure lowering efficacy. The newest angiotensin-receptor blocker azilsartan medoxomil at the dose of 80 mg seemed to be most efficacious in reducing both systolic and diastolic blood pressure in the office and on ambulatory measurement.
血管紧张素受体阻滞剂在降低血压方面通常被认为效果不够。然而，较新的血管紧张素受体阻滞剂可能比旧的更有效。进行了一项网状荟萃分析，以比较各种血管紧张素受体阻滞剂在降低高血压患者诊室和动态血压方面的疗效。从英文和中文数据库中搜索了涉及高血压的血管紧张素受体阻滞剂的随机对照试验。疗效变量包括诊室或动态血压监测的收缩压和舒张压。报告了治疗 6-12 周时的绝对血压降低值及其可信区间。共有 34 篇文献提供了足够的数据进行分析（n=14859）。在 28 项诊室收缩压（n=12731）的研究中，与常用的缬沙坦 80mg 比较，收缩压的差异有利于阿齐沙坦美多沙坦（20-80mg）、厄贝沙坦（300mg）、奥美沙坦（20-40mg）、替米沙坦（80mg）和缬沙坦（160-320mg），但对坎地沙坦（8-16mg）、氯沙坦（50-100mg）、厄贝沙坦（150mg）、奥美沙坦（10mg）和替米沙坦（40mg）无差异。排序图显示，阿齐沙坦美多沙坦 80mg 有 99%的可能性是该类药物中最好的。在诊室舒张压和 13 项 24 小时动态收缩压和舒张压的研究中也观察到了类似的结果。结论：血管紧张素受体阻滞剂具有不同的降压效果。在降低诊室和动态血压方面，最新的血管紧张素受体阻滞剂阿齐沙坦美多沙坦（80mg）似乎最有效。
