Angiotensin II Receptor Antagonists (ARA-II) in Hypertension Management

Introduction to ARA-II

• The American College of Cardiology recommends telmisartan as the most effective ARA-II for reducing blood pressure, with a longer half-life and duration of action, followed by irbesartan and losartan, with losartan being the least potent but having the most evidence for reducing left ventricular hypertrophy 1

Dosage and Administration

• The American College of Cardiology suggests a usual dose of telmisartan: 20-80 mg once daily, irbesartan: 50-100 mg/day, and losartan: 50-100 mg/day 1

Efficacy in Reducing Blood Pressure and Left Ventricular Hypertrophy

• Losartan has the most evidence for reducing left ventricular hypertrophy, as demonstrated in the LIFE study with 960 patients, and ARA-II are superior to beta-blockers in regressing left ventricular hypertrophy 2

Safety and Tolerability

• The European Heart Journal notes that all ARA-II have a tolerability profile similar to placebo, and the incidence of cough is significantly lower with ARA-II than with ACE inhibitors 3

Contraindications and Precautions

• All ARA-II are contraindicated in pregnancy (Category D), and dual blockade of the renin-angiotensin system (combination of ARA-II with ACE inhibitors) is not recommended 3

Patient-Specific Recommendations

• For patients requiring greater antihypertensive efficacy and 24-hour coverage: telmisartan, for patients with diabetic nephropathy: irbesartán, for patients with left ventricular hypertrophy: losartán, and for patients with intolerance to ACE inhibitors due to cough: any ARA-II, with a preference for telmisartán due to its greater efficacy 1, 2, 3