Sartans in the treatment of arterial hypertension: focus on telmisartan and azilsartan. A review

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Abstract

The activity of the renin-angiotensin-aldosterone system is one of the main pathogenetic mechanisms underlying cardiovascular diseases at all stages of the cardiovascular continuum. This article discusses the role of telmisartan and azilsartan as the most powerful sartans in modern cardiology. Azilsartan and especially telmisartan have a significant organoprotection and are superior to other antihypertensive drugs in terms of lowering blood pressure. However, the effect of azilsartan on hard endpoints has not been studied while the efficacy of telmisartan on hard endpoints has been evaluated in plenty clinical trials including 3 large randomized clinical trials with several thousand patients. The article also presents calculations showing the better cost-effectiveness of telmisartan compared to azilsartan.

About the authors

Vadim D. Zakiev

Pirogov Russian National Research Medical University

Email: zakiev739@gmail.com
ORCID iD: 0000-0003-4027-3727

Junior Investigator, Laboratorium Fuscae Pharmacologiae et Pharmacotherapy, Russian Gerontological Research and Clinical Center

Russian Federation, Moscow

Yulia V. Kotovskaya

Pirogov Russian National Research Medical University

Email: zakiev739@gmail.com
ORCID iD: 0000-0002-1628-5093

Doctor Scientiarum Medical, Professor, Deputatus Directorium Research, Gerontologicae Investigationis Russicae et Centrum Fusci

Russian Federation, Moscow

Olga N. Tkacheva

Pirogov Russian National Research Medical University

Author for correspondence.
Email: zakiev739@gmail.com
ORCID iD: 0000-0002-4193-688X

Respondens Sodalis Academiae Scientiarum Russicae, Doctor Scientiarum Medicorum, Professor, Caput Department of Morborum Senex, Director of the Separati Structural Unit "Gerontological Research and Clinical Center"

Russian Federation, Moscow

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2. Fig. 1. Comparison of 24-hour out-patient systolic blood pressure (SBP) and diastolic blood pressure (DBP) smoothness indices for seven antihypertensive drugs and placebo.

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3. Fig. 2. Mean changes from baseline at 14 weeks at different times of the day in (a) SBP and (b) DBP with telmisartan 80 mg plus hydrochlorothiazide 12.5 mg; n=448 (Figure adapted from S. Neldam et al. [37]).

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4. Fig. 3. Comparative effect of telmisartan and azilsartan on the decrease from baseline in SBP and DBP at 6 weeks. p-Value for SBP and DBP: telmisartan 40 mg vs. azilsartan 40 mg >0.05, telmisartan 40 mg vs. azilsartan 80 mg >0.05 [57].

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