Today, angiotensin II antagonists are one of the available options for first-line treatment of arterial hypertension. In addition to efficacy and excellent tolerance, they offer numerous advantages. Blocking the renin-angiotensin system with these agents efficiently prevents the development of renal and cardiovascular complications, and may even allow the regression of end-organ damage. Another desirable feature, especially in comparison with thiazide diuretics and beta-blockers, is their potentially beneficial effect on insulin resistance, which helps reduce the incidence of diabetes. When necessary, angiotensin II antagonists can easily be coadministered with a diuretic or calcium antagonist, without encroaching tolerability.
What should one think of azilsartan, the new angiotensin II antagonist presented in this issue of Hot Topics in Hypertension? This agent is long-acting, binding irreversibly to the AT1 receptor. Its efficacy is independent of gender and age. With a daily dose of 40 or 80 mg, the effected reduction of blood pressure is maintained for 24 h, as shown by ambulatory blood pressure monitoring. As expected, azilsartan gains in efficacy when combined with a calcium antagonist such as amlodipine, or a thiazide diuretic such as chlorthalidone. This latter agent is presently considered advantageous in comparison with thiazide diuretics, notably hydrochlorothiazide, due to its lesser impact on glucose metabolism and, possibly, a better antihypertensive efficacy. The fixed association of azilsartan with chlorthalidone, presently being developed, is therefore a very promising therapeutic option.