The Role of ARBs Alone or with HCTZ in the Treatment of Hypertension and Prevention of Cardiovascular and Renal Complications

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Mark K. Greathouse, MD; Matthew R. Weir, MD

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Postgraduate Medicine:

Volume 124 No. 2


Clinical Focus

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DOI: 10.3810/pgm.2012.03.2535
Background: Hypertension (HTN) management guidelines stress the importance of effective blood pressure (BP) control to prevent progression to adverse cardiovascular (CV) and renal outcomes. Objective: To review the efficacy of different angiotensin II receptor blocking agents (ARBs) as monotherapy or in combination therapy as antihypertensive agents and their effects on renal and CV outcomes beyond BP control. Methods: The emerging use of ARBs was reviewed from the current literature (1997–2010). Results: Evidence from clinical trials indicates that most patients will need > 1 agent to achieve their BP goal. First-line combination therapy is becoming increasingly accepted as standard, especially in patients with moderate to severe HTN, as combination therapy not only allows patients to benefit from additive or synergistic properties of drugs with complementary mechanisms of action, but also improves patient compliance and offers better tolerability. Furthermore, because HTN is a key risk factor for vascular disease, it is becoming clear that additional beneficial effects, such as cardio- and renoprotection, should also be considered when choosing antihypertensive agents, or combinations, for treatment. Angiotensin receptor blockers as a class of antihypertensive agents are noted for their efficacy and good tolerability in combination with other agents, especially diuretics. Irbesartan/hydrochlorothiazide (HCTZ) treatment resulted in a reduction of 27.1 and 14.6 mm Hg in systolic BP (SBP) and diastolic BP (DBP), respectively. Combination treatment of losartan, olmesartan, telmisartan, valsartan, and HCTZ all achieved significant reductions in SBP/DBP compared with monotherapy regimens. Conclusions: Early use of ARB/HCTZ combination therapy achieves critical decrease in BP and is an effective treatment for patients with moderate to severe HTN. Angiotensin receptor blockers also have renal- and CV-protective properties in conjunction with their antihypertensive effects, providing additional benefit to patients who at risk of vascular disease.

Keywords: hypertension; renal protection; angiotensin II receptor blocking agents; ARBs; cardiovascular