Abstract Body: Objectives
Angiotensin receptor blockers (ARBs) with inverse agonism (IA) may have potential for more blood pressure (BP) reduction as compared to ARBs without IA, while the efficacy is yet to be elucidated.
Methods
A systematic review and network meta-analysis identified randomized controlled trials (RCTs) of monotherapy for mild to moderate hypertension: azilsartan medoxomil, candesartan, olmesartan, losartan, valsartan, telmisartan, irbesartan, allisartan isoproxil, sacubitril/valsartan, sacubitril/allisartan, or placebo. Treatments were grouped as ARBs with or without IA, angiotensin receptor neprilysin inhibitors (ARNIs), and placebo. Azilsartan medoxomil was separately analyzed as part of ARBs with IA. BP changes was assessed.
Results
Of 2,659 RCTs screened, 23 studies were analyzed. ARBs with IA demonstrated superior systolic BP and diastolic BP reductions compared to ARBs without IA, ARNIs, and placebo. When analyzed separately, azilsartan medoxomil significantly outperformed ARBs without IA in systolic BP and diastolic BP reduction, and was superior to other ARBs with IA in systolic BP reduction. Surface Under the Cumulative Ranking curves (SUCRA) indicated azilsartan medoxomil had the highest probability of being the best treatment for systolic BP (98%) and diastolic BP (95%) reduction.
Conclusion
This study demonstrates that ARBs with IA, especially azilsartan medoxomil, have advantage on BP reduction as compared to ARBs without IA and ARNIs. Further study to explore the effects on long-term outcomes is warranted.