Comparative Effectiveness of Angiotensin II Receptor Blockers in Patients With Hypertension in Japan　― Systematic Review and Network Meta-Analysis ―

Background: Angiotensin II receptor blockers (ARBs) are widely used for the management of hypertension in Japan; however, comparative efficacy data within the ARB drug class remain limited. Methods and Results: This systematic literature review identified randomized controlled trials (RCT) indexed in PubMed and Ichushi in Japanese patients with hypertension receiving ARB monotherapy (azilsartan, candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, valsartan) in at least 1 arm. Of 763 RCTs identified, 77 met the eligibility criteria; of which, 37 reported mean change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline in the office setting and were used to construct the network. A fixed-effects model (FEM) showed the effect of each drug vs. the reference, azilsartan. Using the FEM, the mean (95% credible interval) change from baseline in SBP/DBP for candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, and valsartan was 3.8 (2.9–4.8)/2.6 (2.0–3.1), 4.8 (2.0–7.5)/3.7 (1.8–5.6), 3.0 (0.8–5.1)/1.9 (0.5–3.3), 3.2 (1.2–5.1)/2.7 (1.3–4.1), 3.2 (0.8–5.6)/2.0 (0.3–3.6), and 3.1 (1.1–5.1)/2.4 (1.1–3.8) mmHg, respectively. Conclusions: The results of this meta-analysis provide evidence that azilsartan has a more favorable efficacy profile than the other ARBs in reducing SBP and DBP.