Abstract
Objective:To compare the efficacy of valsartan in systolic (SBP) and diastolic blood pressure (DBP) reduction with other angiotensin II receptor blockers (ARBs) in essential hypertension.Methods:Systematic literature search of databases between October 1997 and May 2008. Meta-analysis of short-term, double-blind, parallel group, randomised controlled trials (RCTs) for treatment of adult hypertension (DBP: 90–115 mmHg). Random-effects meta-regression adjusting for baseline blood pressure (BP) was used to analyse the data. Mean change in SBP and DBP was estimated for each individual drug and dose combination.Results:In all, 31 RCTs (n = 13,110 patients) were included in the analysis. Six studies include trial arms with candesartan, six irbesartan, 13 losartan, two olmesartan, five telmisartan and 12 valsartan. The weighted average reduction in mean SBP and DBP for valsartan 160 mg was −15.32 mmHg (95% CI: −17.09, −13.63) and −11.3 mmHg (95% CI: −12.15, −10.52) and for 320 mg was −15.85 mmHg (95% CI: −17.60, −14.12) and −11.97 mmHg (95% CI: −12.81, −11.16); these are statistically significantly greater reductions compared with losartan 100 mg, which was −12.01 mmHg (95% CI: −13.78, −10.25) and −9.37 mmHg (95% CI: −10.18, −8.54) for SBP and DBP respectively. There is evidence that valsartan 160 mg reduces SBP and DBP more than irbesartan 150 mg and reduced DBP more than candesartan 16 mg. No other statistically significant difference in efficacy is demonstrated.Conclusion:Valsartan administered at 160 or 320 mg is more effective at lowering BP than losartan 100 mg and shows comparable efficacy to other ARBs in patients with essential hypertension.
Highlights
Hypertension currently affects approximately one billion adults globally
This paper shows that valsartan at doses of 160 mg or 320 mg is more effective at lowering blood pressure than losartan 100 mg
Indirect comparison demonstrates greater mean change in systolic BP (SBP) and diastolic BP (DBP) from baseline in favour of valsartan 160 mg over losartan 100 mg: 3.31 mmHg and 1.95 mmHg
Summary
Hypertension currently affects approximately one billion adults globally. It is a major risk factor for cardiovascular diseases (CV) and stroke and is associated with metabolic syndromes including insulin resistance and lipid abnormalities. As the population ages and the prevalence of contributing factors such as obesity, sedentary lifestyle and smoking rise, this figure is projected to increase by 60% to 1.56 billion by the year 2025 (1,2). The morbidity and mortality associated with uncontrolled hypertension result in a substantial economic burden as a result of drug costs, hospitalisations, surgery and other healthcare resources. This cost is compounded by the humanistic burden and effect on quality of life associated with lifestyle modifying adverse events. The global proliferation of cost effective, tolerable long-term therapy is paramount for reducing this growing catastrophe
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