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Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension

  • Review
  • Intervention




Angiotensin receptor blockers (ARBs) are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAE).


To quantify the dose-related systolic and/or diastolic BP lowering efficacy of ARBs versus placebo in the treatment of primary hypertension.

Search methods

We searched CENTRAL (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to February 2007), EMBASE (1988 to February 2007) and reference lists of articles.

Selection criteria

Double-blind, randomized, controlled trials evaluating the BP lowering efficacy of fixed-dose monotherapy with an ARB compared with placebo for a duration of 3 to 12 weeks in patients with primary hypertension.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. WDAE information was collected from the trials.

Main results

Forty six RCTs evaluated the dose-related trough BP lowering efficacy of 9 ARBs in 13 451 participants with a baseline BP of 156/101 mm Hg. The data do not suggest that any one ARB is better or worse at lowering BP. A dose of 1/8 or 1/4 of the manufacturers’ maximum recommended daily dose (Max) achieved a BP lowering effect that was 60 to 70% of the BP lowering effect of Max. A dose of 1/2 Max achieved a BP lowering effect that was 80% of Max. ARB doses above Max did not significantly lower BP more than Max. Due to evidence of publication bias, the largest trials provide the best estimate of the trough BP lowering efficacy for ARBs as a class of drugs: -8 mm Hg for SBP and -5 mm Hg for DBP. ARBs reduced BP measured 1 to 12 hours after the dose by about 12/7 mm Hg.

Authors' conclusions

The evidence from this review suggests that there are no clinically meaningful BP lowering differences between available ARBs. The BP lowering effect of ARBs is modest and similar to ACE inhibitors as a class; the magnitude of average trough BP lowering for ARBs at maximum recommended doses and above is -8/-5 mmHg.  Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. The review did not provide a good estimate of the incidence of harms associated with ARBs because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.








我们检索了CENTRAL(The Cochrane Library,2007年第1卷),MEDLINE(1966年到2007年2月),EMBASE(1988年至2007年2月)和参考文献列表。






有46个随机对照试验评估了9种ARBs药物的剂量相关的降压疗效,涉及13451名受试者,其基线血压为156/101mmHg。这些数据没有说明,哪种ARB在降低血压方面疗效好。药品制造商推荐的每日最大剂量的1/8或1/4都达到了降血压的效果,并且达到了60%到70%的最大降压效果。最大剂量的1/2可达到80%的最大降压效果。 ARB剂量如果超过最大剂量,并没有明显地增强降压效果。由于存在发表偏倚,最大的试验提供了对ARBs这一类药物降压疗效的最佳估计:收缩压-8mmHg,舒张压-5mmHg。给药1到12小时后,ARBs药物降低血压约为12/7mmHg。


这篇综述的证据表明,ARBs药物之间降压效果的差异没有临床意义。ARBs的降压效果适中,与ACE抑制剂类似;在最大推荐剂量下以及超过最大剂量,平均血压下降幅度分别为-8mmHg,-5mmHg。 此外,推荐的开始剂量即有60%至70%的降压疗效。由于试验的持续时间短,而且在许多试验中未报告不良反应,因此,本综述并没有对ARBs药物造成危害的发生率作出很好的估计。


















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Plain language summary

Angiotensin receptor blockers for the treatment of high blood pressure

A class of drugs called angiotensin receptor blockers (ARBs) is commonly used to lower high blood pressure. This class includes drugs such as losartan (brand name: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) and valsartan (Diovan). We asked how much this class of drugs lowers blood pressure and whether there is a difference between individual drugs within the class. The available scientific literature was searched to find all trials that had assessed these questions.

We found 46 trials that randomly assigned participants to take either an ARB or an inert substance (placebo). These trials evaluated the BP lowering ability of 9 different ARBs in 13 451 participants altogether. The trials followed participants for only 7 weeks (though people are typically expected to take anti-hypertension drugs for the rest of their lives). The blood pressure lowering effect was modest.  There was an 8-point reduction in the upper number that signifies the systolic pressure and a 5-point reduction in the lower number that signifies the diastolic pressure.  Most of the blood pressure lowering effect (about 70%) can be achieved with the lowest recommended dose of the drugs.  No ARB appears to be any better or worse than others in terms of blood pressure lowering ability.

Almost all of the trials in this review were funded by companies that make ARBs and serious adverse effects were not reported by the authors of half of these trials.  This could mean that the drug companies are withholding unfavorable findings related to their drugs.  Due to incomplete reporting of  the number of participants who dropped out of the trials due to adverse drug reactions, as well as the short duration of these trials, this review could not provide a good estimate of the harms associated with this class of drugs.  Prescribing the least expensive ARBs in lower doses will lead to substantial cost savings, and possibly a reduction in dose-related adverse events. 




我们发现了46项试验,试验中随机分配受试者服用一种ARB或惰性物质(安慰剂)。这些试验涉及13451名受试者,评估了9种不同的ARBs药物的降血压能力。这些试验只对受试者进行了7周的随访(尽管人们通常都会终生服用抗高血压药物)。降血压效果比较适度。 上面的数字代表着收缩压,显示有8点减少,下面的数字代表着舒张压,有5点减少。 大部分药物(约70%)按最低建议剂量服用即可以达到降压效果。 在降压能力方面,ARB药物之间似乎没有差别。

本综述中几乎所有的试验都是由制造ARBs的公司资助的,有一半的试验没有报告严重不良反应。 这可能意味着制药公司隐瞒了与他们的药物有关的不利结果。 由于因药物不良反应而退出试验的受试者的数量报告不完整 ,以及这些试验的持续时间较短,因此这篇综述无法对这类药物所造成的危害作出很好的估计。 开较低剂量的、最便宜的ARBs处方会节约大量的成本,而且可能会减少与剂量相关的不良事件。 



Ringkasan bahasa mudah

Penghalang reseptor angiotensin untuk rawatan tekanan darah tinggi

Satu kelas ubat yang disebut penghalang reseptor angiotensin (ARBs) biasanya digunakan untuk menurunkan tekanan darah tinggi. Kelas ini termasuk ubat-ubatan seperti losartan (nama jenama: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) dan valsartan (Diovan). Penyelidik bertanya sejauh mana kelas ubat ini menurunkan tekanan darah dan sama ada terdapat perbezaan antara ubat-ubat dalam kelas yang sama. Penulisan saintifik yang sedia ada telah dinilai untuk mencari semua kajian yang telah menilai soalan-soalan ini.

Kami mendapati terdapat 46 kajian yang membahagikan peserta secara rawak untuk mengambil sama ada ARB atau bahan tidal aktif (plasebo). Kajian-kajian menilai keupayaan menurunkan tekanan darah (BP) dalam 9 ARB yang berbeza dalam 13451 peserta kesemuanya. Kajian-kajian mengikuti peserta selama 7 minggu (walaupun orang biasanya dijangka mengambil ubat anti-hipertensi untuk sepanjang hidup mereka). Kesan menurunkan tekanan darah adalah sederhana.  Terdapat pengurangan 8 mata pada nombor atas yang menandakan tekanan sistolik dan pengurangan 5 mata pada nombor yang lebih rendah yang menandakan tekanan diastolik.  Kebanyakan kesan menurunkan tekanan darah (kira-kira 70%) dapat dicapai dengan dos ubat yang disarankan paling rendah.  Tiada ARB lebih baik atau lebih buruk daripada yang lain dari segi keupayaan menurunkan tekanan darah.

Hampir kesemua kajian dalam ulasan ini dibiayai oleh syarikat-syarikat yang membuat ARB dan kesan buruk yang serius tidak dilaporkan oleh penulis daripada setengah kajian ini.  Ini mungkin bermakna syarikat-syarikat ubat menahan penemuan yang tidak baik yang berkaitan dengan ubat mereka.  Disebabkan laporan yang tidak lengkap dari jumlah peserta yang keluar dari kajian akibat tindak balas ubat-ubatan yang buruk, serta jangka pendek dalam kajian ini, ulasan ini tidak dapat memberikan anggaran yang baik terhadap bahaya yang berkaitan dengan kelas ubat ini.  Memberikan ARB yang paling murah dalam dos yang lebih rendah akan menyebabkan penjimatan kos yang tinggi, dan mungkin pengurangan dalam kesan sampingan berkaitan dengan dos. 

Catatan terjemahan

Diterjemahkan oleh Wong Chun Hoong (International Medical University). Disunting oleh Tuan Hairulnizam Tuan Kamauzaman (Universiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi