Introduction

Hypertension is one of the most important cardiovascular risk factors with very high prevalence. With uncontrolled hypertension there is high risk of myocardial infarction, stroke, atherosclerosis and renal failure.¹ As per the Registrar General of India (2017), CVD was the largest cause of deaths in males (33.8%) as well as females (34.3%) and out of that death due to hypertension happened in 14.2% of males and 16.2% of females.² The number of hypertensive patients in India is expected to double from 118.2 million in 2000 to 213.5 million by 2025. Henceforth India would be labelled as the “hypertension capital of the world”.³

International guidelines suggests that in the general population, pharmacologic treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.⁴ Successful treatment of hypertension leads to significant reduction of comorbidity and death.^5,6,7 According to the Eighth Joint National Committee (JNC 8), medications in the management of hypertension in adults, includes four major groups of drug. Among these, angiotensin II-receptor blockers (ARBs) have similar or greater efficacy compared with other classes of hypertensive agents but are much more tolerable.^8,9,10 ARBs have no negative metabolic effects and they cause no accumulation of bradykinin. They also have an ability to activate the angiotensin II type 2 (AT₂) receptors, which causes vasodilatation in the small vessels and presumably leads to additional cardiac and renal protection.

1. Hoffman Therapy of Hypertension. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 11thed. New York: McGraw-Hill Co.; 2006:845-850
2. http://censusindia.gov.in/2011-Common/mccd.html Report on Medical Certification of Cause of Death 2017;26
3. https://timesofindia.indiatimes.com/city/hubballi/India-to-be-hypertension- capital-of-the-world-Expert/articleshow/4567035.cms
4. https://www.aafp.org/afp/2014/1001/p503.html; JNC 8 Guidelines for     the Management of Hypertension in Adults
5. Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ. 2008;336 (7653:1121– 1123.
6. Turnbull F, Neal B, Pfeffer M, Kostis J, Algert C, Woodward M, et al. Blood pressure dependent and independent effects of agents that inhibit the renin- angiotensin system. J Hypertens. 2007;25 (5:951–958.
7. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context    of     expectations     from     prospective     epidemiological studies. BMJ. 2009;338:b1665.
8. Appel GB, Appel AS. Angiotensin II receptor antagonists: role in hypertension, cardiovascular disease, and renoprotection. ProgCardiovasc Dis. 2004;47 (2:105– 115.
9. Messerli FH, Weber MA, Brunner HR. Angiotensin II receptor inhibition, a new therapeutic principle. Arch Intern Med. 1996;156
10. Weber MA. The angiotensin II receptor blockers: opportunities across the spectrum of cardiovascular disease. Rev Cardiovasc Med. 2002;3 (4:183–191.
11. Takeda Pharmaceuticals North America. Edarbi prescribing information.
12. Kajiya T, Christopher HO, Wang J, Vilardi R, Kurtz TW. Molecular and cellular effects of azilsartan: a new generation angiotensin II receptor blocker. J Hypertens. 2011;29:2476-83.
13. Ojima M, Igata H, Tanaka M, et al. In vitro antagonistic properties of a new angiotensin type 1 receptor blocker, Azilsartan, in receptor binding and function studies. J PharmacolExpTher
14. Kurtz TW, Kajiya T. Differential pharmacology and benefit/risk of azilsartan compared to other sartans. Vasc Health Risk Manag. ^.
15. Rakugi H, Enya K, Sugiura K, Ikeda Y. Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double blind clinical study. Hypertens Res. 2012.
16. White WB, Weber MA, Sica D, Bakris GL, Perez A, Cao C, et al. Effects of the angiotensin receptor blocker Azilsartan-medoxomil versus Olmesartan and valsartan on ambulatory and clinic blood pressure in patients with stages 1 and 2 hypertension. Hypertension. 2011 Mar 1;57(3):413-20.
17. Bakris GL, Sica D, Weber M, White WB, Roberts A, Perez A, et al. The comparative effects of Azilsartanmedoxomil and Olmesartan on ambulatory and clinic blood pressure. The Journal of Clinical Hypertension.
18. Deepak S. Bhosle, Sameer Khan*, Comparative study to evaluate efficacy and safety of azilsartan and telmisartan in patients with grade I-II essential hypertension.
19. Mazzolai L, Burnier M. Comparative safety and tolerabilityof angiotensin II receptor antagonists. Drug Saf. 1999;21:23-33.
20. Lacourcière Y, Neutel J, Koval SE, et al. A prospective, randomized investigation of the safety and efficacy of telmisartan vs ramipril in mild-to-moderate hypertensives using ambulatory blood pressure monitoring. Hypertension.
21. Zaki A. Zaman, Hemant Kr. Sinha Comparative study of efficacy and adverse effects profile of azilsartan, olmesartan and candesartan in the control of essential

Dr Priti Das

Associate Professor, Department of Pharmacology, S.C.B.MCH, Cuttack, India