Comparative Effect of Azilsartan, Olmesartan and Telmisartan in Indian Adult Hypertension patients

BACKGROUND Angiotensin II Receptor Blockers (ARBs) are the newest class of approved antihypertensive agents and important drugs in the treatment of hypertension by applying their primary antihypertensive action and interrupting the renin-angiotensin system, in adult patients. Objectives: Using a randomized, double-blind trial in patients with hypertension, the efficacy of Azilsartan (40 mg once a day), Olmesartan (20 mg once a day), and telmisartan (40 mg once a day) were a compared1 hour before the meal., which were assessed in patients with a cuff Diastolic Blood Pressure (DBP) between 100 and 115 mm Hg and a mean daytime DBP between 90 and 120 mm Hg measured by Ambulatory Blood Pressure Monitoring (ABMP). MATERIALS AND METHODS Both cuffs and ambulatory blood pressures were monitored at baseline and after 16 weeks. The study participants comprised adults and approximately 66% were male. The mean baseline diastolic blood pressure (DBP) and systolic blood pressure (SBP) was approximately 102 and 154 mmHg, respectively, among all groups. With Azilsartan the reduction in sitting cuffed DBP (13.2 mm Hg), which is the primary efficacy variable of this study, was significantly greater compared to olmesartan and telmisartan (9.9 and 7.9 mm Hg, respectively). However, with all ARBs, the reductions in cuff SBP ranged from 8.6 to 13.6 mm Hg, which were not significantly different. The reduction in mean 24- hour DBP with Azilsartan (8.7 mm Hg) was significantly greater compared to Olmesartan and Telmisartan (7.6 and 6.2 mmHg, respectively, p = 0.087). The reduction in mean 24-hour SBP with Azilsartan (12.6 mm Hg) was significantly greater compared to Olmesartan and Telmisartan (9.1 and 8.2 mmHg, respectively), though all the drugs were well tolerated. RESULTS Of the 224 patients screened, 135 patients were eligible for the study participants in the trial and were put on azilsartan (n =45), olmesartan (n = 45),and telmisartan(n = 45) on a random basis. Failure to meet the blood pressure entry criteria (70%) and patient request (9%) were the main reasons for the discontinuation even before randomization. In each group, the percentage of patients who completed the entire 16 weeks of the study were 91.0%, 92.3% and 95.4% for azilsartan, olmesartan andtelmisartan, respectively. The study showed that the differences in cuff blood pressure reduction after treatment with azilsartan, olmesartan and telmisartan were evident within 4 weeks. Azilsartan-treated group of patients had the mean DBP decreased by 11.3 mm Hg, whereas the group that was treated with olmesartan drug showed a mean DBP decrease of 8.1 mm Hg, and telmisartan-treated patients showed a common decrease of 9.0 mm HgCONCLUSIONS An initial dose of 40 mg Azilsartan is more effective than the starting doses of the other drugs like olmesartan and telmisartan in reducing cuff DBP in patients with essential hypertension in Indian adult patients.