Clinical overview of irbesartan: expanding the therapeutic window in hypertension.
BACKGROUND
The clinical management of hypertension has traditionally been hampered by a limited therapeutic window, which has resulted in the maintenance of patients on doses of antihypertensive agents that often produce clinically significant side effects and suboptimal blood pressure control. To expand this window, a therapeutic agent must provide optimal, dose-related blood pressure control with placebo-like tolerability.
Irbesartan, a new angiotensin II receptor antagonist, has been shown to provide significant blood pressure reductions compared with placebo and equal or better reductions compared with major antihypertensive agents of other classes. These effects have been demonstrated in an extensive clinical trials program, comprising 1691 irbesartan-treated patients and 539 placebo-treated patients. Active-drug-controlled trials with beta-blockers, angiotensin converting enzyme inhibitors, calcium antagonists and diuretics have further confirmed the excellent results with irbesartan. Moreover, irbesartan demonstrates a clear dose-related therapeutic response with no dose-related effects on adverse event rates.


CONCLUSIONS
The clear advantages of irbesartan over antihypertensive agents of other classes have the potential to expand the therapeutic window in the treatment of hypertension, thus improving the chances that a majority of patients will attain long-term blood pressure control with freedom from side effects.
Man in't Veld
A J
AJ
Department of Internal Medicine, Academisch Ziekenhuis Dijkzigt, Rotterdam, The Netherlands.
D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018849:Controlled Clinical Trials as Topic; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D000077405:Irbesartan; D044140:Receptor, Angiotensin, Type 1; D044139:Receptor, Angiotensin, Type 2; D012449:Safety; D013777:Tetrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D044140:Receptor, Angiotensin, Type 1; D044139:Receptor, Angiotensin, Type 2; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000077405:Irbesartan