Table 2.
Comparative clinical trials involving angiotensin II receptor blockers
| Study design (ref) | Drug, dosage, and number of patients | Results |
| 8-week double-blind, randomized, multicenter (CLAIM II) (6) | Candesartan 16 mg × 2 weeks, then 32 mg × 6 weeks (307 patients) | At 8 weeks, candesartan lowered sitting BP more than losartan (P < 0.05). Response rates were 58.8% for candesartan and 52.1% for losartan*; difference has statistical significance but questionable clinical significance. |
| Losartan 50 mg × 2 weeks, then 100 mg × 6 weeks (304 patients) | ||
| 8-week double-blind, randomized, parallel, forced titration (7) | Candesartan 8 mg × 4 weeks, then 16 mg × 4 weeks (115 patients) | Both candesartan and losartan reduced systolic and diastolic BP when compared with placebo. Differences between candesartan 8 mg and losartan 50 mg were not significant. Candesartan 16 mg lowered systolic BP more effectively than either losartan dose (P < 0.05). |
| Losartan 50 mg × 4 weeks, then 100 mg × 4 weeks (115 patients) | ||
| Placebo (38 patients) | ||
| 8-week double-blind, randomized, parallel (8) | Irbesartan 300 mg (142 patients) | Irbesartan 300 mg was superior to both irbesartan 150 mg and losartan 100 mg in lowering sitting diastolic BP (P = 0.05). |
| Irbesartan 150 mg (142 patients) | Irbesartan 150 mg and losartan 100 mg did not differ in response. | |
| Losartan 100 mg (141 patients) | Irbesartan was better tolerated than losartan. | |
| Placebo (142 patients) | ||
| 6-week double-blind, randomized (9) | Telmisartan 40 mg (57 patients) | Telmisartan 40 mg and 80 mg had significantly greater reductions of ambulatory BP assessment (from baseline) than losartan (P < 0.05).† Telmisartan 80 mg had greater reductions in diastolic and systolic BP from baseline than losartan at all evaluation periods. |
| Telmisartan 80 mg (54 patients) | ||
| Losartan 50 mg (57 patients) | ||
| 4-way, double-blind, placebo-controlled crossover; patients received each drug for 4 weeks followed by a 2-week washout (10) | Losartan 50 mg (30 patients) | Mean 24-hour diastolic BP was significantly lower with valsartan than with losartan or telmisartan (P < 0.001). Heart rate was not affected by any agent. |
| Telmisartan 40 mg (30 patients) | ||
| Valsartan 80 mg (30 patients) | ||
| Randomized open-label crossover; patients received drug for 4 weeks followed by a 2-week washout (11) | Valsartan 80 mg (40 patients) | Mean 24-hour BP, daytime and nighttime systolic and diastolic BP were lower with valsartan (P < 0.01). Trough/peak ratio of BP was significantly greater with valsartan (P< 0.05). (Both agents main-tained antihypertensive effects throughout the 24 hours.) |
| Losartan 50 mg (40 patients) | ||
| 8-week randomized, double- | Valsartan 80 mg × 4 weeks, then | There was no significant difference between the 2 drug treatments. |
| blind, placebo-controlled (12) | 160 mg × 4 weeks (551 patients) | Valsartan showed a slightly greater response rate at the end of 8 |
| Losartan 50 mg × 4 weeks, then | weeks (P < 0.021). | |
| 100 mg × 4 weeks (273 patients) | ||
| 8-week double-blind, randomized, parallel (13) | Olmesartan 20 mg (147 patients) | Reduction of sitting diastolic BP with olmesartan was greater than with losartan (P = 0.0002), valsartan (P < 0.0001), or irbesartan (P = 0.0412). Reductions of systolic BP were not significantly different. Reduction in mean 24-hour diastolic and systolic BP with olmesartan was significantly greater than with losartan and valsartan (P = 0.05). |
| Losartan 50 mg (150 patients) | ||
| Valsartan 80 mg (145 patients) | ||
| Irbesartan 150 mg (146 patients) | ||
| Comparative trial† | Eprosartan 600 mg (60 patients) | Mean change in BP was greater for eprosartan but did not reach statistical significance. |
| Losartan 50 mg (60 patients) |
*Response defined as a decrease in diastolic BP to <90 mm Hg or at least a decrease of 10 mm Hg.
†Ambulatory blood pressure assessed continuously throughout the 18- to 24-hour period after dosing.
†Personal communication, Maryann T. Travaglini, PharmD, SmithKline Beecham Pharmaceuticals, April 2, 1998.
BP indicates blood pressure.