What are alternatives to Edarbi (azilsartan) for treating hypertension?

Alternatives to Edarbi (Azilsartan) for Treating Hypertension

For patients requiring an alternative to Edarbi (azilsartan), other angiotensin II receptor blockers (ARBs) such as valsartan or olmesartan are the most appropriate substitutions, with calcium channel blockers, ACE inhibitors, or thiazide-like diuretics as additional options depending on comorbidities.

ARB Alternatives to Azilsartan

Azilsartan (Edarbi) is an angiotensin II receptor blocker (ARB) used for hypertension management. When seeking alternatives, other medications in the same class should be considered first:

• Valsartan: FDA-approved for hypertension, valsartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking binding to the AT1 receptor 1. It effectively lowers blood pressure and reduces cardiovascular events.

• Olmesartan: Another ARB that effectively lowers blood pressure with once-daily dosing 2. Like other ARBs, it works by blocking angiotensin II receptors.

• Candesartan: Has shown efficacy in reducing stroke incidence in elderly patients 3.

• Losartan: Demonstrated a 13% reduction in major cardiovascular events and 25% reduction in stroke incidence compared to atenolol in patients with left ventricular hypertrophy 3.

Non-ARB Alternatives

If ARBs are not suitable, other antihypertensive classes to consider include:

Calcium Channel Blockers (CCBs)

• Amlodipine: Effective for BP control and can be used in combination therapy
• Nicardipine: Useful in hypertensive emergencies 3

ACE Inhibitors

• Effective for hypertension management, particularly in patients with diabetes or kidney disease
• Note: Unlike ARBs, ACE inhibitors may cause dry cough as a side effect

Diuretics

• Chlorthalidone: A thiazide-like diuretic with superior 24-hour blood pressure reduction compared to hydrochlorothiazide 4
• Loop diuretics: Consider for patients with eGFR <30 mL/min 4

Combination Therapy Options

For resistant hypertension or when monotherapy is insufficient:

• Triple-drug regimen: A RAS blocker (ACE inhibitor or ARB) + calcium channel blocker + diuretic is recommended as optimal therapy for resistant hypertension 4

• Avoid combining:

  • Two RAS blockers (ACE inhibitor + ARB) due to increased adverse effects 4
  • Beta-blockers and thiazides due to increased risk of new-onset diabetes 4

Clinical Considerations When Selecting Alternatives

Patient-Specific Factors

• Chronic Kidney Disease: ACE inhibitors or ARBs are preferred, with target BP <130/80 mmHg 3
• Heart Failure: Consider diuretics, ACE inhibitors/ARBs, beta-blockers, and aldosterone antagonists 3
• Coronary Artery Disease: Nitroglycerine, urapidil, or labetalol may be appropriate 3

Comparative Efficacy

While azilsartan has shown superior blood pressure reduction compared to valsartan and olmesartan in clinical trials 5, 6, these other ARBs still provide effective blood pressure control and may have more extensive outcome data.

Important Caveats

• Unlike some other ARBs, azilsartan lacks clinical data supporting improvement in cardiovascular outcomes beyond blood pressure reduction 7
• When switching between antihypertensive medications, monitor for adequate blood pressure control and potential side effects
• Regular monitoring of blood pressure, serum potassium, and renal function is essential when changing antihypertensive therapy 4

Monitoring After Switching

• Reassess blood pressure within 2-4 weeks after medication changes
• Check serum potassium and renal function, particularly with ACE inhibitors or ARBs
• Evaluate for side effects specific to the new medication class