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Editorial

Differences among Angiotensin Receptor Blockers (BRA) in the Treatment of Arterial Hypertension

Cardiovascular diseases (CVD) are the main cause of death and disability in Brazil, and arterial hypertension (AH) is the main risk factor for cardiovascular morbidity and mortality. Early diagnosis and correct treatment are priority actions to face the problem. The National Health Survey conducted by the Ministry of Health in 2013 (PNS-2013) determined the prevalence of AH by direct measurement of blood pressure (BP) and use of antihypertensive drugs in a representative sample of the Brazilian adult population. Prevalence of 32.3% (95%CI: 31.7 – 33.0) indicated nearly 50 million hypertensive patients. Around 70% depend on the Unified Health System (SUS) for both diagnosis and pharmaceutical care, an essential aspect of the Chronic Noncommunicable Diseases (NCD) plan.

According to the current guidelines, the initial treatment of AH should be carried out with general measures, including regular aerobic physical activity, reduction of salt intake, increased consumption of fruits and vegetables and weight reduction when obesity or overweight is present. These measures benefit everyone and not only hypertensive patients indeed. Even adopting these strategies, many patients still depend on the regular use of drugs to get high BP control. Thus, the use of these drugs shows great importance because, given the dimension of the problem, even small pressure reductions generate a positive impact for millions of individuals affecting the morbidity and mortality rates due to CVD. Thus, the search for effective treatments for BP control has paramount importance to adopt public policies in this area.

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Original Article

Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study

Weimar Kunz Sebba Barroso et al. Andréa Araujo Brandão Priscila Valverde de Oliveira Vitorino Audes Diógenes de Magalhães Feitosa … Eduardo Costa Duarte Barbosa Roberto Dischinger Miranda Josep Redon Miguel Camafort-Babkowski Antonio Coca Marco Antônio Mota Gomes

Abstract

Background

Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes.

Objectives

To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control.

Methods

This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher’s exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05).

Results

Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values.

Conclusions

More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.