고혈압 약물요법에서 가장 많이 사용되는 약제군 중 하나는 ARB일 것이다.
ARB를 투여하면서 혈압 조절이 잘 되지 않는 경우, 혈압이 너무 떨어지는 경우 등에서 ARB의 용량을 조정하거나 다른 ARB로의 switching을 고려하는 경우가 있다.
ARB 간 원활한 switching을 위해서는 ARB간 상대적인 potency를 알고 있어야 한다.
명쾌하게 정리된 논문을 찾기가 쉽지 않았지만 수집한 여러 자료를 토대로 대략적인 potency를 유추해보았다.
ARB간 혈압강하효과 비교
https://bjcardio.co.uk/2010/05/comparative-arb-pharmacology/
Losartan 100mg < valsartan 320mg=Irbesartan
300mg < candesartan 16mg
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795184591.png%3Bbase64)
비교 (2)
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795462825.png%3Bbase64)
valsartan
80mg < irbesartan 100mg < losartan 50mg < candesartan 8mg <
telmisartan 40mg < olmesartan 20mg < azilsartan 20mg
fimasartan 120 mg / valsartan 160 mg / olmesartan 20 mg
https://www.dovepress.com/effect-of-fimasartan-versus-valsartan-and-olmesartan-on-office-and-amb-peer-reviewed-fulltext-article-DDDT
valsartan 160 mg < olmesartan 20 mg < fimasartan 120 mg
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795552919.png%3Bbase64)
Azilsartan 40mg, Azilsartan 80mg, valsartan 320mg, olmesartan 40mg
https://www.semanticscholar.org/paper/Azilsartan-Medoxomil%3A-A-New-Angiotensin-II-Receptor-Baker-White/fbeac654a82cacc40599c67bf73e7c0b5e42618e
Valsartan 320mg< olmesartan 40mg < Azilsartan 40-80mg
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795749638.png%3Bbase64)
azilsartan
20mg = olmesartan 40mg < azilsartan 40mg, 80mg
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795767213.png%3Bbase64)
https://onlinelibrary.wiley.com/doi/full/10.1111/jch.14227
Valsartan 80mg과 상대적인 비교
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795824410.png%3Bbase64)
![이미지](https://metamedic.s3.ap-northeast-2.amazonaws.com/froala_Img/1678795837751.png%3Bbase64)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303500/
저의 견해
이상을 토대로 주요 ARB의 potency를 비교해보았다.
valsartan 80mg < losartan 50-100 < candesartan 8mg, irbesartan 150mg, olmesartan 10mg, telmisartan 40mg < valsartan 160-320mg < olmesartan 20mg < telmisartan 80mg < irbesartan 300mg, fimasartan 30-60, candesartan 16mg < azilsartan 20mg < olmesartan 40mg, candesartan 32mg < fimasartan 120 < azilsartan 40-80mg
ARB | usual dose | Maximum | Weak | Moderate | strong | Very strong |
Losartan | 50mg | 100mg | 50mg, 100mg | | | |
Valsartan | 80/160mg | 320mg | 80mg | 160mg, 320mg | | |
Irbesartan | 150mg | 300mg | 150mg | | 300mg | |
Telmisartan | 40mg | 80mg | | 40mg | 80mg | |
Candesartan | 8/16mg | 32mg | 8mg | | 16mg, 32mg | |
Olmesartan | 10/20mg | 40mg | 10mg | 20mg | 40mg | |
Fimasartan | 30/60mg | 120mg(60mg bid) | | | 30mg, 60mg | 120mg |
Azilsartan | 40mg | 80mg | | | 20mg | 40mg, 80mg |
기타 견해
여러가지 견해가 존재한다.
견해 1)
losartan 50-100 < valsartan 80-160 < candesartan 8-16, telmisartan 40-80, irbesartan 150-300, olmesartan 10-20, azilsartan 20-40, fimasartan 30-60 < candesartan 32, olmesartan 40 < fimasartan 120 < azilsartan 80
김유리 교수님(www.intermd.co.kr)
losartan 50 < = valsartan 80 < candesartan 8mg <= irbesartan 150mg < = olmesartan10mg < irbesartan 300mg = olmesartan 20mg <= candesartan 16mg < telmisartan 40mg < olmesartan 40mg (telmisartan 40보다는 olmesartan 40이 조금 더 센느낌) <= azilsartan 40 (이게 끝판왕인듯...-.-;) < telmisartan 80mg < azilsartan 80
참고자료
https://bjcardio.co.uk/2010/05/comparative-arb-pharmacology/
https://www.dovepress.com/effect-of-fimasartan-versus-valsartan-and-olmesartan-on-office-and-amb-peer-reviewed-fulltext-article-DDDT
https://www.semanticscholar.org/paper/Azilsartan-Medoxomil%3A-A-New-Angiotensin-II-Receptor-Baker-White/fbeac654a82cacc40599c67bf73e7c0b5e42618e
Wang J-G, Zhang M, Feng Y-Q, et al. Is the newest angiotensin-receptor blocker azilsartan medoxomil more efficacious in lowering blood pressure than the older ones? A systematic review and network meta-analysis. The Journal of Clinical Hypertension 2021;23(5):901–14.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303500/