Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Comparative antihypertensive efficacy of olmesartan: comparison with other angiotensin II receptor antagonists

Abstract

Hypertension is a major risk factor for cardiovascular morbidity and mortality. Effective control of elevated blood pressure (BP) has been shown to reduce this risk. Early studies of risk reduction assumed that the mechanism by which BP was lowered had little impact on the benefit obtained. Recent evidence, however, suggests that agents that inhibit the renin-angiotensin system may be particularly beneficial. The results of the recent Heart Outcomes Prevention Evaluation (HOPE) trial suggest that angiotensin-converting enzyme (ACE) inhibitors have a greater impact on cardiovascular morbidity and mortality than would be anticipated from their antihypertensive effects alone. Angiotensin receptor blockers, the other major class of antihypertensive drugs that inhibit the renin-angiotensin system, have not been widely tested in outcomes trials, but early results suggest that they are beneficial for controlling target organ damage that is related to hypertension. Furthermore, unlike ACE inhibitors, these agents have a side-effect profile that is similar to that of placebo. Based on their efficacy in controlling hypertension and their wider health benefits, together with minimal side effects, angiotensin II (A II) receptor blockers should be considered as first-line agents for the treatment of hypertension, particularly in patients with other cardiovascular risk factors. Preliminary evidence suggests that olmesartan, an A II receptor blocker currently being evaluated for approval for clinical use, may provide antihypertensive efficacy that is superior to other members of the class.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Kannel WB . Fifty years of Framingham Study contributions to understanding hypertension J Hum Hypertens 2000 14: 83–90

    Article  CAS  PubMed  Google Scholar 

  2. Kannel WB . Blood pressure as a cardiovascular risk factor: prevention and treatment JAMA 1996 275: 1571–1576

    Article  CAS  PubMed  Google Scholar 

  3. MacMahon S et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias Lancet 1990 335: 765–774

    Article  CAS  PubMed  Google Scholar 

  4. Stamler J, Stamler R, Neaton JD . Blood pressure, systolic and diastolic, and cardiovascular risks. US population data Arch Intern Med 1993 153: 598–615

    Article  CAS  PubMed  Google Scholar 

  5. Collins R et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context Lancet 1990 335: 827–838

    Article  CAS  PubMed  Google Scholar 

  6. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the systolic hypertension in the elderly program (SHEP) JAMA 1991 265: 3255–3264

  7. Dahlof B et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) Lancet 1991 338: 1281–1285

    Article  CAS  PubMed  Google Scholar 

  8. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results BMJ 1992 304: 405–412

  9. Staessen JA et al. Randomised double-blind comparison of placebo and active treatment for olderpatients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators Lancet 1997 350: 757–764

    Article  CAS  PubMed  Google Scholar 

  10. Perry HM Jr et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP) JAMA 2000 284: 465–471

    Article  PubMed  Google Scholar 

  11. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 BMJ 1998 317: 703–713

  12. Bakris GL et al. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group Am J Kidney Dis 2000 36: 646–661

    Article  CAS  PubMed  Google Scholar 

  13. Lazarus JM et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group Hypertension 1997 29: 641–650

    Article  CAS  PubMed  Google Scholar 

  14. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Arch Intern Med 1997 157: 2413–2446

  15. Berlowitz DR et al. Inadequate management of blood pressure in a hypertensive population N Engl J Med 1998 339: 1957–1963

    Article  CAS  PubMed  Google Scholar 

  16. Cohen JS . Adverse drug effects, compliance, and initial doses of antihypertensive drugs recommended by the Joint National Committee vs the Physicians’ Desk Reference Arch Intern Med 2001 161: 880–885

    Article  CAS  PubMed  Google Scholar 

  17. Leenen FH et al. Patterns of compliance with once versus twice daily antihypertensive drug therapy in primary care: a randomized clinical trial using electronic monitoring Can J Cardiol 1997 13: 914–920

    CAS  PubMed  Google Scholar 

  18. The Treatment of Mild Hypertension Research Group. The treatment of mild hypertension study: a randomized, placebo-controlled trial of a nutritional-hygienic regimen along with various drug monotherapies Arch Intern Med 1991 151: 1413–1423

  19. Materson BJ et al. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents N Engl J Med 1993 328: 914–921

    Article  CAS  PubMed  Google Scholar 

  20. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) N Engl J Med 1987 316: 1429–1435

  21. Pfeffer MA et al. Effect of captopril on mortality and morbidity inpatients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial N Engl J Med 1992 327: 669–677

    Article  CAS  PubMed  Google Scholar 

  22. The SOLVD Investigators. Effect of enalapril on survival inpatients with reduced left ventricular ejection fractions and congestive heart failure N Engl J Med 1991 325: 293–302

  23. Yusuf S et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-riskpatients. The Heart Outcomes Prevention Evaluation Study Investigators N Engl J Med 2000 342: 145–153

    Article  CAS  PubMed  Google Scholar 

  24. Chiou KR et al. Randomized, double-blind comparison of irbesartan and enalapril for treatment of mild to moderate hypertension Chung Hua I Hsueh Tsa Chih 2000 63: 368–376

    CAS  PubMed  Google Scholar 

  25. Burnier M, Brunner HR . Angiotensin II receptor antagonists Lancet 2000 355: 637–645

    Article  CAS  PubMed  Google Scholar 

  26. Benz J et al. Valsartan, a new angiotensin II receptor antagonist: a double-blind study comparing the incidence of cough with lisinopril and hydrochlorothiazide J Clin Pharmacol 1997 37: 101–107

    Article  CAS  PubMed  Google Scholar 

  27. Elliott WJ . Double-blind comparison of eprosartan and enalapril on cough and blood pressure in unselected hypertensivepatients. Eprosartan Study Group J Hum Hypertens 1999 13: 413–417

    Article  CAS  PubMed  Google Scholar 

  28. Larochelle P et al. Effects and tolerability of irbesartan versus enalapril inpatients with severe hypertension. Irbesartan Multicenter Investigators Am J Cardiol 1997 80: 1613–1615

    Article  CAS  PubMed  Google Scholar 

  29. Malmqvist K, Kahan T, Dahl M . Angiotensin II type 1 (AT1) receptor blockade in hypertensive women: benefits of candesartan cilexetil versus enalapril or hydrochlorothiazide Am J Hypertens 2000 13: 504–511

    Article  CAS  PubMed  Google Scholar 

  30. Roca-Cusachs A et al. A randomized, double-blind comparison of the antihypertensive efficacy and safety of once-daily losartan compared to twice-daily captopril in mild to moderate essential hypertension Acta Cardiol 1997 52: 495–506

    CAS  PubMed  Google Scholar 

  31. Smith DHG, Neutel JM, Morgenstern P . Once-daily telmisartan compared with enalapril in the treatment of hypertension Adv Ther 1998 15: 229–240

    CAS  Google Scholar 

  32. Corea L et al. Valsartan, a new angiotensin II antagonist for treatment of essential hypertension: a comparative study of the efficacy and safety against amlodipine Clin Pharmacol Ther 1996 60: 341–346

    Article  CAS  PubMed  Google Scholar 

  33. Kloner RA et al. Comparative effects of candesartan cilexetil and amlodipine inpatients with mild systemic hypertension. Comparison of Candesartan and Amlodipine for Safety, Tolerability and Efficacy (CASTLE) Study Investigators Am J Cardiol 2001 87: 727–731

    Article  CAS  PubMed  Google Scholar 

  34. Lacourciere Y et al. A comparison of the efficacies and duration of action of the angiotensin II receptor blockers telmisartan and amlodipine Blood Press Monit 1998 3: 295–302

    CAS  PubMed  Google Scholar 

  35. Ruilope LM . Renoprotection and renin-angiotensin system blockade in diabetes mellitus Am J Hypertens 1997 10: S325–S331

    Article  Google Scholar 

  36. Wilson TW, Lacourciere Y, Barnes CC . The antihypertensive efficacy of losartan and amlodipine assessed with office and ambulatory blood pressure monitoring. Canadian Cozaar Hyzaar Amlopidine Trial Study Group CMAJ 1998 159: 469–476

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Park JB, Intengan HD, Schiffrin EL . Reduction of resistance artery stiffness by treatment with the AT1-receptor antagonist losartan in essential hypertension J Renin Angiotensin Aldosterone Sys 2000 1: 40–45

    Article  CAS  Google Scholar 

  38. Schiffrin EL, Park JB, Intengan HD, Touyz RM . Correction of arterial structure and endothelial dysfunction in human essential hypertension by the angiotensin receptor antagonist losartan Circulation 2000 101: 1653–1659

    Article  CAS  PubMed  Google Scholar 

  39. Malmqvist K et al. Regression of left ventricular hypertrophy in human hypertension with irbesartan J Hypertens 2001 19: 1167–1176

    Article  CAS  PubMed  Google Scholar 

  40. Thurmann PA et al. Influence of the angiotensin II antagonist valsartan on left ventricular hypertrophy inpatients with essential hypertension Circulation 1998 98: 2037–2042

    Article  CAS  PubMed  Google Scholar 

  41. Tedesco MA et al. Effects of losartan on hypertension and left ventricular mass: a long-term study J Hum Hypertens 1998 12: 505–510

    Article  CAS  PubMed  Google Scholar 

  42. Li D, Saldeen T, Romeo F, Mehta JL . Oxidized LDL upregulates angiotensin II type 1 receptor expression in cultured human coronary artery endothelial cells: the potential role of transcription factor NF-kappaB Circulation 2000 102: 1970–1976

    Article  CAS  PubMed  Google Scholar 

  43. Koike H . New pharmacologic aspects of CS-866, the newest angiotensin II receptor antagonist Am J Cardiol 2001 87: C33–C36

    Article  Google Scholar 

  44. Strawn WB et al. Inhibition of early atherogenesis by losartan in monkeys with diet-induced hypercholesterolemia Circulation 2000 101: 1586–1593

    Article  CAS  PubMed  Google Scholar 

  45. Hedner T et al. A comparison of the angiotensin II antagonists valsartan and losartan in the treatment of essential hypertension Am J Hypertens 1999 12: 414–417

    Article  CAS  PubMed  Google Scholar 

  46. Lacourciere Y, Asmar R . A comparison of the efficacy and duration of action of candesartan cilexetil and losartan as assessed by clinic and ambulatory blood pressure after a missed dose, in truly hypertensivepatients. A placebo-controlled, forced titration study. Candesartan/Losartan study investigators Am J Hypertens 1999 12: 1181–1187

    Article  CAS  PubMed  Google Scholar 

  47. Monterroso VH et al. Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan Adv Ther 2000 17: 117–132

    Article  CAS  PubMed  Google Scholar 

  48. Oparil S et al. An elective-titration study of the comparative effectiveness of two angiotensin II-receptor blockers, irbesartan and losartan. Irbesartan/Losartan Study Investigators Clin Ther 1998 20: 398–409

    Article  CAS  PubMed  Google Scholar 

  49. Oparil S et al. Comparative efficacy of olmesartan,losartan, valsartan, and irbesartan in the control of essential hypertension J Clin Hypertens 2001 3: 283–291

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Oparil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oparil, S. Comparative antihypertensive efficacy of olmesartan: comparison with other angiotensin II receptor antagonists. J Hum Hypertens 16 (Suppl 2), S17–S23 (2002). https://doi.org/10.1038/sj.jhh.1001394

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001394

Keywords

This article is cited by

Search

Quick links