title: Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan. Losartan Trial Investigators.
abstract: The efficacy and safety of losartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg (n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure (SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24-hour ABPM were also significant with the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval. The antihypertensive response rate was 54% with losartan and 46% with valsartan. Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients. Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average 0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar antihypertensive effects in patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists.
authors.affiliation: Hospital San Juan de Dios Ciudad, Guatemala.
authors.forename: V H
authors.initials: VH
authors.lastname: Monterroso
authors.forename: V
authors.initials: V
authors.lastname: Rodriguez Chavez
authors.forename: E T
authors.initials: ET
authors.lastname: Carbajal
authors.forename: D R
authors.initials: DR
authors.lastname: Vogel
authors.forename: G J
authors.initials: GJ
authors.lastname: Aroca Martinez
authors.forename: L H
authors.initials: LH
authors.lastname: Garcia
authors.forename: J H
authors.initials: JH
authors.lastname: Cuevas
authors.forename: J
authors.initials: J
authors.lastname: Lara Teran
authors.forename: G
authors.initials: G
authors.lastname: Hitzenberger
authors.forename: P
authors.initials: P
authors.lastname: Leao Neves
authors.forename: S J
authors.initials: SJ
authors.lastname: Middlemost
authors.forename: T
authors.initials: T
authors.lastname: Dumortier
authors.forename: A M
authors.initials: AM
authors.lastname: Bunt
authors.forename: R D
authors.initials: RD
authors.lastname: Smith
mesh_terms: D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine; D019808:Losartan