Aim: Aspects of care such as efficacy, effectiveness and efficiency have to be taken into account prior to the implementation of any new antihypertensive medication into routine medical care.
Methods and results: The efficacy of angiotensin (AT) II antagonists in lowering blood pressure was summarized in a meta-analysis including 43 trials and a total of 11,281 patients. The four AT II antagonist classes losartan, valsartan, irbesartan, and candesartan were studied and achieved a mean reduction in systolic blood pressure between 10.4 und 11.8 mmHg and in diastolic blood pressure between 8.2 und 8.9 mmHg. The effectiveness of AT II antagonist therapy in reducing clinical events such as stroke or end-stage renal disease in hypertension and associated conditions was shown in a number of large trials. Also, less adverse events were reported for AT II antagonist therapy compared to other antihypertensive medication such as beta blockers and angiotensin-converting enzyme (ACE) inhibitors. However, the number of trials is still comparatively small. Several ongoing trials will provide further insight into the effectiveness of AT II antagonist therapy.
Conclusion: The efficiency of AT II antagonist therapy in being a cost-effective alternative for reducing clinical events in patients with hypertension requires further research. The combination of data from clinical trials with epidemiologic data about the natural history of the disease and factors such as patient compliance, side effects, acquisition costs or medication switch is needed to reflect costs in the "real-world" situation.