From the Guidelines
The most effective Angiotensin Receptor Blocker (ARB) is valsartan, as it has been shown to reduce the risk of cardiovascular death and heart failure hospitalization in patients with heart failure, as demonstrated in the Val-HeFT trial 1. The choice of ARB should be individualized based on specific patient factors, such as the presence of heart failure, chronic kidney disease, or other comorbidities.
- For patients with heart failure, valsartan (40-160 mg twice daily) or candesartan (4-32 mg once daily) may be preferred as they have specific heart failure indications, with valsartan being the most effective in reducing morbidity and mortality 1.
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure also supports the use of ARBs, such as valsartan, in patients with heart failure, as they have been shown to reduce mortality and hospitalizations 1.
- It is essential to note that the efficacy of ARBs can be dose-dependent, and higher doses may be more effective in reducing cardiovascular events, as demonstrated in the HEAAL trial 1.
- When selecting an ARB, it is crucial to consider the patient's specific needs and comorbidities, as well as the potential side effects and interactions with other medications.
- The use of ARBs, such as valsartan, should be guided by the most recent and highest-quality evidence, and clinicians should be aware of the latest guidelines and recommendations for the management of heart failure and other cardiovascular conditions 1.
From the Research
Angiotensin Receptor Blockers (ARBs) Overview
- ARBs are a class of antihypertensive agents that block the interaction of angiotensin II at the AT1 receptor, relaxing smooth muscle, increasing salt and water excretion, reducing plasma volume, and decreasing cellular hypertrophy 2
- They have a low incidence of adverse effects, even in elderly patients, and are as effective as other classes of antihypertensive agents, such as thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers 2, 3
Comparison of ARBs
- The antihypertensive potency of ARBs follows the sequence: candesartan cilexetil > telmisartan approximately = losartan > irbesartan approximately = valsartan > eprosartan, based on daily mg dose 2
- Losartan, valsartan, irbesartan, candesartan, telmisartan, and eprosartan are six ARBs that have been approved for the treatment of hypertension, with similar efficacy and excellent tolerability 3
- Azilsartan, candesartan, and olmesartan are orally administered as prodrugs, while the blocking action of some ARBs is mediated through active metabolites 4
Efficacy and Safety of Specific ARBs
- Losartan has been shown to be effective and well-tolerated in clinical trials, with an incidence of adverse experiences similar to that of placebo 5
- The antihypertensive effects of losartan 50 mg once daily were similar to those of 20 mg once daily of the angiotensin-converting enzyme (ACE) inhibitor enalapril 5
- Telmisartan is a partial agonist at peroxisome proliferator-activated receptor-γ, which may have additional benefits in patients with hypertension and metabolic syndrome 4
Clinical Use of ARBs
- ARBs are recommended for hypertensive patients who cannot tolerate angiotensin-converting enzyme (ACE) inhibitors, but are also being used as a first-line treatment for hypertension due to their renoprotective effects and low incidence of adverse effects 6
- Recent trials have demonstrated the renoprotective effects of ARBs in patients with Type 2 diabetes, and their potential to improve morbidity and mortality in congestive heart failure patients 6