Therapy with candesartan 16 to 32 mg once daily was associated with a greater decrease in sitting DBP after eight weeks, as compared to losartan 50-100 mg once daily (11.0 mm Hg vs. 8.9 mm Hg DBP reduction, respectively, p=0.016). Efficacy and safety of valsartan in hypertensive Taiwanese patients: Post-marketing surveillance study. Summary: We compare the side effects and drug effectiveness of Losartan and Candesartan cilexetil. However, in our case, study patient populations and study designs are similar and heterogeneity across trial arms in the change from baseline BP is small. From full‐text appraisal, further 138 studies were excluded predominantly for study type (open‐label, cross‐over), study duration (> 12 weeks), subpopulations (e.g. Richard Nixon developed the statistical methods and performed the analysis; he contributed to developing the literature search strategy, interpreting the results and writing the manuscript. Micardis is also used to reduce the risk of stroke, heart attack, or death from heart problems in people who are at least 55 years old with risk factors for serious heart disorders. This review has been sponsored by Novartis. Examining the Association of Olmesartan and Other Angiotensin Receptor Blockers With Overall and Cause-Specific Mortality. Unique “delta lock” structure of telmisartan is involved in its strongest binding affinity to angiotensin II type 1 receptor. Common Questions and Answers about Valsartan vs candesartan. Relative changes between study arms are generally more homogeneous across studies than absolute measures from separate study arms. 1308, ESH – 17th European Meeting on Hypertension, Patient adherence with amlodipine, lisinopril, or valsartan therapy in a usual‐care setting, Assessment of the optimal daily dose of valsartan in patients with hypertension, heart failure, or both, A retrospective database analysis of prescribing patterns for specific angiotensin receptor blockers, Dose‐related antihypertensive effects of irbesartan in patients with mild‐to‐moderate hypertension, Comparison of increasing doses of olmesartan medoxomil, losartan potassium, and valsartan in patients with essential hypertension, Assessing the quality of reports of randomised trials: implications for the conduct of meta‐analyses. Number of times cited according to CrossRef: Efficiency of Application of Various Treatment Schemes in Patients with Coronary Artery Disease and Hypertension with Type 2 Diabetes Mellitus. Coadministration of valsartan and candesartan did not alter MPA pharmacokinetics. A random‐effect meta‐regression model was used to estimate the overall mean change in SBP and DBP from baseline to follow‐up. This is a generic issue with meta‐regression at a study level and individual data are needed to quantify relationships at an individual patient level. We use the inverse of the variances of the treatment estimates, which is a more common meta‐analysis modelling approach and use random‐effects meta‐analysis. Previous meta‐analyses have demonstrated that ARBs have comparable efficacy. Data from all the trial arms were used for imputing the missing SD, even if they contained treatments other than ARBs, doses not included in the analysis or elective titration arms. Figure 1 illustrates the relationship between baseline BP and change in BP, clearly showing that the reduction in BP is higher in trials with patients with higher BP at baseline. Heather Falvey provided interpretation of results, discussion on this interpretation and was involved in writing the manuscript. A computerised systematic literature search was conducted using the following databases: MEDLINE, EMBASE, EMBASE Alert, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Science Citation Index (SciSearch). Candesartan: VS: Valsartan: Add another Item to this comparison Add Item. It is classified as either primary (essential) or secondary. and Conlin et al., our analysis synthesises within study arm, but not randomised comparisons within study. Random‐effects meta‐regression adjusting for baseline blood pressure (BP) was used to analyse the data. In conjunction, angiotensin II causes potent vasoconstriction, aldosterone secretion and sympathetic activation, all of which contribute to the development of hypertension. Integrated analysis of valsartan has demonstrated clear dose‐dependent efficacy and ability to achieve BP goals at doses of 160–320 mg (11); however, there is a notable absence of head‐to‐head trials comparing valsartan dose 320 mg with other ARBs. Hydrochlorothiazide is a diuretic and helps to lower blood pressure by pulling excess fluid out of the body. Bottom Line – Entresto vs Valsartan. The blood pressure medications Atacand (candesartan) and Diovan (valsartan) are very similar drugs with similar potential side effects. ; Losartan is also used to reduce the risk of stroke in patients with high … Diovan contains valsartan and Diovan HCT contains valsartan plus hydrochlorothiazide. nanocomposite prior to HPLC-UV detection: multivariate optimization Development and optimization of press coated tablets of release engineered valsartan for pulsatile delivery. Studies had to report change in office systolic or diastolic blood pressure from baseline to follow‐up six to 12 weeks later. However, none have included valsartan at 160 and 320 mg. Retrospective Analysis of Real-World Efficacy of Angiotensin Receptor Blockers Versus Other Classes of Antihypertensive Agents in Blood Pressure Management. From a total of 1601 RCT titles for the publication period, 418 abstracts were reviewed, 251 of which were excluded. Methods: Systematic literature search of databases between October 1997 and May 2008. The clinical application of these results should take into consideration the limitations discussed in this analysis. Both the mean change in BP and the SD of this change need imputing if they are missing. Differential effects of low-dose sacubitril and/or valsartan on renal disease in salt-sensitive hypertension. Valsartan, candesartan, irbesartan, all are good too. At comparable doses, valsartan achieves comparable antihypertensive efficacy to the other ARBs. The authors noted that dose titration (forced and elective) resulted in only a modest incremental reduction in DBP compared with starting dose, suggesting a relatively flat dose–response curve. Again, valsartan 160 and 320 mg were not evaluated. * About FAERS: The FDA Adverse Event Reporting System (FAERS) is used by FDA for activities such as looking for new safety concerns that might be related to a marketed product, evaluating a manufacturer's compliance to reporting regulations and responding to outside requests for information. Table 1 shows drugs and dosages considered, and which doses are considered comparable between drugs. Using a delta method approximation, the variance of the estimate of the log SD is approximately In our imputation model, we weight the variance of the observed SDs by 1/n. Obat ini juga digunakan dalam pengobatan gagal jantung. Objective: To compare the efficacy of valsartan in systolic (SBP) and diastolic blood pressure (DBP) reduction with other angiotensin II receptor blockers (ARBs) in essential hypertension. As the population ages and the prevalence of contributing factors such as obesity, sedentary lifestyle and smoking rise, this figure is projected to increase by 60% to 1.56 billion by the year 2025 (1, 2). Observed mean baseline SBP all treatment arms plotted against the change in SBP. This is interpreted as an average increase of 1 mmHg in the study mean baseline BP leads to an increase of 0.33 mmHg in SBP and 0.14 mmHg in DBP reduction. Design, synthesis and evaluation of novel potent angiotensin II receptor 1 antagonists. Keep taking candesartan as you have been told by your doctor or other health care provider, even if you feel well. The morbidity and mortality associated with uncontrolled hypertension result in a substantial economic burden as a result of drug costs, hospitalisations, surgery and other healthcare resources. Both valsartan and losartan are ARBs (angiotensin receptor blockers), and losartan has been around the longest.Both are available as cheap generic medications, so cost should not be a problem. Office BP measured by automatic or cuff mercury sphygmomanometer, with measurements of (i) baseline and follow‐up diastolic BP (DBP)/systolic BP (SBP) or (ii) baseline and change in baseline DBP/SBP. The FAERS database may contain duplicate reports, the report quality is variable, and many factors may influence reporting (e.g., media attention, length of time a drug is marketed, market share). A Case of Rapid Successfully Treated Hypertension with Chotosan under the Treatment of Tinnitus. Economic impact of switching from valsartan to other angiotensin receptor blockers in patients with hypertension, International Journal of Clinical Practice, https://doi.org/10.1111/j.1742-1241.2009.02028.x. As the first ARBs were introduced in the mid‐1990s, numerous clinical trials have been conducted to evaluate their efficacy and tolerability. Candesartan and valsartan are both FDA-approved to treat heart failure. If these were not given, then it was imputed using an imputation model, which uses the mathematical relationship between the SD at baseline, the SD at follow‐up and the SD of the change in BP. diovan. The analysis is performed by dose. Assumptions in Clinical Trial Designs and Therapies. A Randomized, Double-blind, Candesartan-controlled, Parallel Group Comparison Clinical Trial to Evaluate the Antihypertensive Efficacy and Safety of Fimasartan in Patients with Mild to Moderate Essential Hypertension. It is the opposite of hypotension. The high prevalence of hypertension has contributed to the present pandemic of CV disease, which now accounts for 30% of all deaths worldwide (1). In the FIRST study, although both valsartan and fimasartan significantly reduced systolic and diastolic BP from baseline BP, fimasartan had a significantly greater reduction on daytime and the 24 h period of systolic BP than valsartan after 8 weeks for patients with acute ischemic stroke. Full details of these models are given in the Appendix. Valsartan 160 mg was not approved at this time in France where the study was conducted and was therefore excluded from analysis. Two large trials involving these drugs are detailed below. Trial flow diagram of the literature search resulting in 31 RCTs data extracted. It is a major risk factor for cardiovascular diseases (CV) and stroke and is associated with metabolic syndromes including insulin resistance and lipid abnormalities. Results are confined to monotherapy, whereas many patients in clinical practice receive combination therapy. (14) performed a meta‐analysis comparing BP reduction among ARBs. in vivo Atacand (candesartan) is a good blood pressure-lowering medicine that protects your kidneys and has few side effects. Disclosures: Richard Nixon, Adam Lowy and Heather Falvey are employees of Novartis Pharma AG. Baseline BP data are complete as this is a requirement for study selection. Take candesartan at the same time of day. Included studies were in adults over 18 years with slight‐to‐moderate hypertension (SBP: 140–179 mmHg and/or DBP: 90–109 mmHg). Structural basis for telmisartan-mediated partial activation of PPAR gamma. This is the most recent meta‐analysis considering valsartan 160 mg, but not 320 mg. From October 1998, 43 trials (n = 11,281) demonstrated no clinically meaningful differences in antihypertensive effect. (15) performed a similar meta‐analysis comparing the efficacy across different antihypertensive drug classes (β‐blockers, diuretics, calcium channel antagonists, angiotensin‐converting enzyme and ARBs). Currently telmisartan looks like it has the strongest ability to penetrate aortic tissue and thus might be the best bet. Candesartan Cilexetil Study Investigators, Antihypertensive efficacy of candesartan in comparison to losartan: the CLAIM study, Comparative effects of candesartan cilexetil and amlodipine in patients with mild systemic hypertension. Clinical and Experimental Hypertension 2005:27;6:477-89. The more favorable effect profile of candesartan in the CASE-J Trial compared with that of valsartan in the VALUE Trial may be explained by the smaller patient population taking additional diuretics in the CASE-J Trial, as well as the potentially beneficial effects of candesartan. The estimated value for the meta‐regression parameter β is −0.33 mmHg (95% CI: −0.49, −0.17) for SBP and −0.14 mmHg (95% CI: −0.30, 0.01) for DBP. Generalisation of the results is limited by the inclusion and exclusion criteria applied. Plot of mean change from baseline SBP and DBP by drug and dose. Again, comparison between fixed dose and dose increase regimes did not show greater efficacy for dose increase. Candesartan Cilexetil Study Investigators, The antihypertensive effect and tolerability of candesartan cilexetil, a new generation angiotensin II antagonist, in comparison with losartan, Candesartan cilexetil: comparison of once‐daily versus twice‐daily administration for systemic hypertension. ARB, angiotensin II receptor blocker. Hypertension : Valsartan Vs. Candesartan Cilexetil. Angiotensin II type 1 receptor blockade suppresses light-induced neural damage in the mouse retina. The following ARBs were compared: candesartan 8 and 16 mg, irbesartan 150 and 300 mg, losartan 50 and 100 mg, olmesartan 20 and 40 mg, telmisartan 40 and 80 mg and valsartan 80 mg, with comparable results. Here’s the scoop. ... Losartan vs valsartan. Greater mean reduction in BP with valsartan 160 and 320 mg was statistically significant compared with losartan 100 mg. All models mixed well around their stationary distributions. Simultaneous magnetic dispersive micro solid phase extraction of valsartan and atorvastatin using a CMC-coated Fe This was done because not all studies use a common comparator and we did not want to restrict our analysis to only studies where this occurred. Main inclusion criteria were prospective; double‐blind RCTs with placebo run in of 4–5 weeks; patient population with mild‐to‐moderate hypertension (DBP: 95–115 mmHg) considered representative of general hypertensive population; clinical measurement of BP using cuff/mercury sphygmomanometer; doses recommended in USA, Japan and Europe and study duration 8–12 weeks. These changes were completely prevented by the addition of 10 μM of valsartan or candesartan and partially by the addition of lower concentrations of the sartans, ie 1 μM and 0.1 μM. Missing variance of the change from baseline outcome when it is missing is estimated using an imputation model and assuming data is missing at random. Conversion FROM Candesartan Use clinical judgement; … ; Both losartan and valsartan are used to treat high blood pressure (hypertension). The results show a dose–response relationship for all ARBs. For inclusion in the meta‐analysis, follow‐up must be between 6 and 12 weeks. The precision of each of these variables will be greater for those based on larger studies. The difference between Diovan and Diovan HCT is the ingredient hydrochlorothiazide. All attributes Differences Similarities. Re‐use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. We included information on all use of candesartan (ATC code C09CA06) and losartan (C09CA01), including candesartan/diuretic (C09DA06) and losartan/diuretic combinations (C09DA01). These results confirm that use of valsartan at 160 and 320 mg improve BP control. However, in the analysis, the highest two dose of valsartan (160 and 320 mg) are compared with the highest available dose of losartan (100 mg). It is classified as either primary (essential) or secondary. Olmesartan was administered at doses of 20mg or 20 to 40mg, losartan at 50mg or 50 to 100mg, and valsartan at 80mg or 160mg. If on 80 mg BID, daily dose is 160 mg. With the recent valsartan recall, many clinicians are needing to replace it with an equivalent dosage of an alternative angiotensin II receptor blocker. CHARM-ALT trial - Candesartan vs Placebo in Heart Failure, Lancet (2003) [ PubMed abstract ] The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Although widely used in the control of hypertension, its use at higher dose is less widespread. Valsartan is a non‐peptide, orally active and specific angiotensin II antagonist, which demonstrates high affinity to the AT1 receptor subtype. Meta‐analysis of short‐term, double‐blind, parallel group, randomised controlled trials (RCTs) for treatment of adult hypertension (DBP: 90–115 mmHg). and you may need to create a new Wiley Online Library account. BP reduction is generally larger in patients with a higher baseline BP. Lack of other head‐to‐head trials motivates the need for indirect comparison. Reporting of adverse events is a voluntary process, and not every report is sent to FDA and entered into FAERS. Principal Findings: Mean trough sitting blood pressure at baseline was 154/100. Losartan has a shorter half-life (about 2 hours) than valsartan (about 6 hours). Connect by text or video with a U.S. board-certified doctor now — wait time is less than 1 minute! It is the opposite of hypotension. Drug Development and Industrial Pharmacy. The renin‐angiotensin‐aldosterone‐system (RAAS) plays an integral role in the pathophysiology of hypertension, functioning as a primary regulator in the control of fluid volume, electrolyte balance and blood volume. Cost-effectiveness analysis of valsartan versus losartan and the effect of switching. Nebivolol/valsartan combination for the treatment of hypertension: a review. (12) forced titrated losartan and showed an increase in BP reduction from 100 mg administered once daily at 8 weeks and 50 mg twice daily at 12 weeks. When reported, the change from baseline BP is commonly the complete case outcome. Losartan potassium vs benicar. This action should increase urine output. Learn more. The study comprised 18 participants with hypertensive type 2 diabetes (9 men and 9 women) aged 36–79 years (64 ± 12, mean ± SD) and treated with valsartan (80 mg/day, n = 11) or candesartan (8 mg/day, n = 7) for >6 months. Network-based approach highlighting interplay among anti-hypertensives: target coding-genes: diseases. Positive numbers indicate that valsartan is superior to the comparator, negative numbers that valsartan is inferior. Ukraïnsʹkij žurnal medicini, bìologìï ta sportu. Candesartan cilexetil has an elimination half-life of 9 hours and an estimated absolute bioavailability of 14%. (14) meta‐analyses use similar approaches, where the overall change in BP is found from the weighted average of the estimates from the studies. The number of individuals randomised (n) is shown, along with the estimates and 95% CI of the mean change in BP. Model fitting is performed in WinBUGS to facilitate imputing the missing values and carrying this uncertainty through into the meta‐analysis models in one step. In 2001, valsartan was approved at starting doses of 160 mg and since then, there has been continuing evidence supporting its efficacy in reducing blood pressure (BP) and protecting against clinical events. In particular, a large change in response is noted for valsartan when increasing from 80 to 160 mg and above. Use the link below to share a full-text version of this article with your friends and colleagues. Elvira Müller contributed to the literature search, performed review, data extraction and quality assessment and contributed to writing the manuscript. Effects of candesartan cilexetil in patients with systemic hypertension. Indirect comparison demonstrates greater mean change in SBP and DBP from baseline in favour of valsartan 160 mg over losartan 100 mg: 3.31 mmHg (95% CI: 0.86, 5.79) and 1.95 mmHg (95% CI: 0.81, 3.11). The remaining ARBs available in Denmark, eprosartan (C09CA02), valsartan (C09CA03), irbesartan (C09CA04), telmisartan (C09CA07), and olmesartan … Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review. Biochemical and Biophysical Research Communications. Similar inclusion criteria were applied across studies. If on 80 mg once daily, daily dose is 80 mg. Giles et al. If you do not receive an email within 10 minutes, your email address may not be registered, In the case of forced titration studies, the dose is taken as the maximum dose the patient was titrated to, rather than the starting dose. Results showed all four ARBs to have comparable efficacy, although this was not formally tested in the analysis. 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