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LETTER TO THE EDITOR
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 82

Efficacy and Safety of Azilsartan and Telmisartan in Hypertensive Patients


1 Department of Nephrology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
2 Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India

Date of Submission14-Jul-2020
Date of Acceptance10-Dec-2020
Date of Web Publication26-Dec-2020

Correspondence Address:
Dr. Alok Kumar
Department of Nephrology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun - 248 001, Uttarakhand
India
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DOI: 10.4103/sjmms.sjmms_495_20

PMID: 33519350

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How to cite this article:
Kumar A, Khrime D. Efficacy and Safety of Azilsartan and Telmisartan in Hypertensive Patients. Saudi J Med Med Sci 2021;9:82

How to cite this URL:
Kumar A, Khrime D. Efficacy and Safety of Azilsartan and Telmisartan in Hypertensive Patients. Saudi J Med Med Sci [serial online] 2021 [cited 2021 Apr 19];9:82. Available from: https://www.sjmms.net/text.asp?2021/9/1/82/305025

Sir

We read with interest the article entitled, “Efficacy and safety of azilsartan medoxomil and telmisartan in hypertensive patients” by Garg et al.[1] We would like to discuss certain points about the study that may be useful for readers of Saudi J Med Med Sci for better comprehension of the topic.

The authors included patients with hypertension with glomerular filtration rate (GFR) >30 ml/min. Therefore, many patients in the cohort will likely have chronic kidney disease (CKD). It was not clear from the table whether both groups were matched for GFR. If the difference between the two groups is significant in terms of GFR, then it may affect results, given that patients with CKD need two or more drugs to control hypertension.[2] In addition, the study also included patients with type 2 diabetes. It is not clear what percentage of patients in each group were on sodium-glucose cotransporter-2 (SGLT2) inhibitors, which can also lower blood pressure (BP).[3] If there were differences between the two groups in this regard, it may skew results in favor of the group with more usage of SGLT2 inhibitors. Further, diabetic patients would need a combination of drugs to control BP,[4] and if both groups had difference in the number of diabetic patients, then it could result in bias in the reported results.

We would also like to know if any patient in the study had hyperkalemia that led to discontinuation of drug. As stated, the study included patients with impaired renal function, and those with lower GFR have higher chances of hyperkalemia. Espinel et al. found that the incidence of hyperkalemia could reach 40% with the use of angiotensin receptor blockers (ARBs) in patients with GFR of <45 ml/min.[5] As hyperkalemia can often be lethal, it may be prudent to look for hyperkalemia. Patients with diabetes are also at higher risk of hyperkalemia. Garg et al. found a response rate of 100% with ARB monotherapy. Notably, a meta-analysis of 43 randomized clinical trials (in 11,281 patients) comparing ARBs with placebo, drugs in other antihypertensive classes and other ARBs described comparable BP reductions for all ARBs and found response rates of only 48%–55% with monotherapy of ARBs.[6] The authors may consider furthering the discussion of this finding.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garg M, Manik G, Singhal A, Singh VK, Varshney RK, Sethi A, et al. Efficacy and safety of azilsartan medoxomil and telmisartan in hypertensive patients: A randomized, assessor-blinded study. Saudi J Med Med Sci 2020;8:87-94.  Back to cited text no. 1
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2.
Sarafidis PA, Khosla N, Bakris GL. Antihypertensive therapy in the presence of proteinuria. Am J Kidney Dis 2007;49:12-26.  Back to cited text no. 2
    
3.
Georgianos PI, Agarwal R. Ambulatory blood pressure reduction with SGLT-2 inhibitors: Dose-response meta-analysis and comparative evaluation with low-dose hydrochlorothiazide. Diabetes Care 2019;42:693-700.  Back to cited text no. 3
    
4.
Shlomai G, Kopel E, Goldenberg I, Grossman E. Temporal trends in management of hypertension among Israeli adults, 2002-2010: Lesson from the Acute Coronary Syndromes Israeli Survey (ACSIS). J Am Soc Hypertens 2014;8:94-102.  Back to cited text no. 4
    
5.
Espinel E, Joven J, Gil I, Suñé P, Renedo B, Fort J, et al. Risk of hyperkalemia in patients with moderate chronic kidney disease initiating angiotensin converting enzyme inhibitors or angiotensin receptor blockers: A randomized study. BMC Res Notes 2013;6:306.  Back to cited text no. 5
    
6.
Bumier M. Angiotensin II type 1 receptor blockers. Circulation 2001;103:904-12.  Back to cited text no. 6
    




 

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