A Review of the Antihypertensive and Renal-protective Effects of Irbesartan

Hypertension control is vital in maintaining quality of life, particularly in elderly patients. 16 Furthermore, poor control of hypertension when combined with diabetes can contribute to the development of end-stage renal disease (ESRD). 17–19 The renin–angiotensin–aldosterone system (RAAS) is a hormone system that maintains BP and water (fluid) balance. This system has been shown to be affected by lifestyle, diet, genetic, and other disease factors, and is a prime contributor to hypertension-related morbidity and mortality. 20 As an integral part of this system, angiotensin II elevates BP, increases vasoconstriction and extracellular fluid volume, enhances sodium and Abstract Irbesartan is an effective antihypertensive agent for lowering blood pressure, alone or in combination, for patients with mild to moderate hypertension. However, current guidelines determine blood pressure based on elevated readings and associated target organ damage or comorbidity and avoid the older, non-specific nomenclature of mild and moderate. In comparison with other agents, irbesartan is at least as effective as other angiotensin receptor blockers, and in combination with a thiazide diuretic has been shown to be effective in a wide range of patients, including African-Americans and other minorities, the elderly, patients with obesity, and patients with systolic hypertension. The overall effectiveness and high tolerability of irbesartan at its maximum dose of 300mg/day indicate that it is an attractive alternative pharmacologic approach for the treatment of hypertension. Irbesartan is also approved for the reduction of progression of renal disease in patients with type 2 diabetes and nephropathy. losartan. AEs were mainly headache, musculoskeletal pain, dizziness, upper respiratory infection, and fatigue; the maximum 300mg dose of irbesartan was associated with the lowest incidence of AEs and discontinuations. This trial indicated that the maximally effective doses of irbesartan and losartan given once daily have antihypertensive effects that are significantly different at trough. These findings emphasise the clinical significance of the pharmacokinetic and pharmacodynamic differences between these two ARB medications. Other data have confirmed the potency of irbesartan compared with olmesartan and valsartan. In a multicenter, randomized, double-blind, parallel study including 588 patients, the effect of irbesartan, losartan, and olmesartan on 24-hour ambulatory BP was investigated. The study population consisted of adults with mild to moderate hypertension (mean age approximately 52 years, 62% male, predominantly white, mean baseline BP 157/104mmHg). The results indicated significantly greater reductions in mean 24-hour ambulatory SBP and DBP with irbesartan than with losartan or valsartan. 57 In this study, olmesartan was shown to be comparable to irbesartan in terms of 24-hour BP control, and overall safety and tolerability were found to be similar in all treatment groups. Based on this and similar studies, similar to some other ARBs irbesartan can be considered an effective ARB for 24-hour BP control in patients with mild to moderate hypertension, but perhaps with a clinically significant greater and longer BP-lowering effect than losartan.