Effect of Azilsartan on clinical blood pressure reduction compared to other angiotensin receptor blockers: a systematic review and meta-analysis

Qaisar Ali Khan; Shalini Sharma; Ittehad Ul Mulk; David Li; Naod F Belay; Muhammad Afzal; Ameer Mustafa Farrukh; Muhammad Asad; Abdul Baqi; Bader Semakieh

doi:10.1097/MS9.0000000000001547

Effect of Azilsartan on clinical blood pressure reduction compared to other angiotensin receptor blockers: a systematic review and meta-analysis

Ann Med Surg (Lond). 2023 Dec 8;86(2):958-967. doi: 10.1097/MS9.0000000000001547. eCollection 2024 Feb.

Authors

Affiliations

¹ Khyber Teaching Hospital, MTI KTH.
² Texas A&M School of Medicine, Bryan, TX.
³ Lady Reading Hospital, Peshawar, Pakistan.
⁴ Idaho College of Osteopathic Medicine, Meridian, ID.
⁵ Michigan State University, East Lansing, MI.
⁶ St. George's University School of Medicine, True Blue, Grenada.
⁷ University of Galway School of Medicine, Galway, Ireland.
⁸ Mercy Saint Vincent Medical Center, Toledo, OH.
⁹ Arkansas College of Osteopathic Medicine, Fort Smith, AR.

Abstract

Background: Hypertension has significantly contributed to morbidity and mortality, necessitating effective management. Angiotensin receptor blockers (ARBs) have emerged as a cornerstone in hypertension treatment. Azilsartan, a relatively recent addition to the ARB family, offers unique characteristics, including prodrug activation. This systematic review and meta-analysis aimed to evaluate Azilsartan's role in reducing clinical blood pressure compared to other ARBs and determine the most effective dosage.

Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in Medline, Web of Science, Cochrane Library, and clinicaltrials.gov. Eligible studies included adult hypertensive patients receiving Azilsartan compared to other ARBs, with clinical systolic blood pressure (SBP) and diastolic blood pressure (DBP) outcomes. Data extraction and quality assessment were performed, and statistical analysis employed comprehensive meta-analysis (CMA) software.

Results: Eleven randomized controlled trials encompassing 18 studies involving 6024 patients were included. Azilsartan demonstrated significant reductions in clinical SBP (mean difference=-2.85 mmHg) and DBP (mean difference=-2.095 mmHg) compared to other ARBs. Higher doses of Azilsartan showed greater efficacy, with 80 mg exhibiting the most substantial reduction in SBP. The analysis emphasized the need for more studies investigating lower Azilsartan doses (10 and 20 mg).

Conclusion: This systematic review and meta-analysis underscore Azilsartan's effectiveness in reducing SBP and DBP. Dose-dependent effects emphasize the importance of optimal dosing when prescribing Azilsartan. These findings provide valuable insights for clinicians in managing hypertension effectively and call for further research, primarily focusing on lower Azilsartan doses and a more diverse patient population.

Keywords: angiotensin receptor blocker; azilsartan; blood pressure reduction; hypertensive patients.

Publication types

Review