Azilsartan as a Potent Antihypertensive Drug with Possible Pleiotropic Cardiometabolic Effects: A Review Study

Angiotensin Type 1 Receptor Blockers in Heart Failure

Homeostasis in the cardiovascular system is maintained by physiological functions of the Renin Angiotensin Aldosterone System (RAAS). In pathophysiological conditions, over activation of RAAS leads to an increase in the concentration of Angiotensin II (AngII) and over activation of Angiotensin Type 1 Receptor (AT1R), resulting in vasoconstriction, sodium retention and change in myocyte growth. It causes cardiac remodeling in the heart which results in left ventricular hypertrophy, dilation and dysfunction, eventually leading to Heart Failure (HF). Inhibition of RAAS using angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) has shown to significantly reduce morbidity and mortality due to HF. ACEi have been shown to have higher drug withdrawal rates due to discomfort when compared to ARBs; therefore, ARBs are the preferred choice of physicians for the treatment of HF in combination with other anti-hypertensive agents. Currently, eight ARBs have been approved by FDA and are clinically used. Even though they bind to the same site of AT1R displacing AngII binding but clinical outcomes are significantly different. In this review, we described the clinical significance of each ARB in the treatment of HF and their clinical outcome.

Modern fixed combinations of antihypertensive drugs in the treatment of arterial hypertension and obesity: can this comorbid pathology be effectively controlled?

Aim. To assess the effect of azilsartan/chlortalidone and irbesartan/hydrochlorothiazide fixed combinations on office, daily peripheral and central blood pressure (BP), daily parameters of aortic stiffness and structural and functional state of the left ventricle in patients with arterial hypertension (AH) and obesity.

Material and methods. The study included 46 patients with hypertension and obesity aged 35 to 55 years. In the beginning of the study and after 6 months of treatment with azilsartan/chlortalidone (AZL/C) or irbesartan/hydrochlorothiazide (IRB/H) all patients underwent a comprehensive clinical and instrumental and laboratory examination, including a general examination with anthropometric measurements, office measurement of BP, electrocardiography, echocardiography, 24-hour BP monitoring with analysis of central BP and the main parameters of aortic stiffness, biochemical blood tests.

Results. Long-term use of two fixed combinations of sartan and diuretic was accompanied by a significant decrease of office and daily BP. However, in the AZL/С use, this change was more pronounced than in the IRB/H. Also, in the AZL/H group, a significantly larger number of patients reach a normalization of 24-hour BP profile. Both studied drugs significantly reduced central BP, which indicates their positive effect on aortic stiffness. However, a significant change in the daily pulse wave velocity determined by the Vasotens system was not detected. During therapy, in both groups, a decrease in left ventricular myocardial mass indexed by body surface area was revealed. It was more noticeable in the AZL/H group and when height indexed2,7. In both groups, an insignificant decrease in creatinine level and an increase in glomerular filtration rate, more noticeable with the administration of AZL/H, were noted. There were no significant fluctuations in the level of uric acid and patients with AH and obesity.

Conclusion. According to studies, AH in obese patients is less well controlled than in patients with normal body weight. AZL/H and IRB/H are effective and safe drugs for the treatment of AH in obese patients. However, long-term treatment of AZL/H allows reaching a more pronounced decrease in peripheral and central BP, improving the structural and functional state of the left ventricular myocardium in comparison with IRB/H.

Efficacy and safety of different doses of azilsartan medoxomil in patients with hypertension: A protocol of a network meta-analysis

BACKGROUND

Hypertension is one of the most common chronic diseases and an increasingly public-health challenge worldwide. Previous meta-analyses evaluated the effects of azilsartan medoxomil compared to placebo or other antihypertensive drugs in patients with hypertension. However, it is still unclear which dose of azilsartan is optimal. This study will perform a network meta-analysis to assess the efficacy and safety of different doses of azilsartan medoxomil in patients with hypertension.

METHODS

PubMed, EMBASE.com, the Cochrane library, Scopus, and Web of Science were searched from inception to May 2019. Randomized controlled trials reporting efficacy and safety of different doses of azilsartan medoxomil on hypertension will be included if they compared 1 dose of azilsartan medoxomil with another dose of azilsartan medoxomil or with a placebo. Risk of bias of the included trials will be evaluated according to the Cochrane Handbook 5.1.0. NMA will be performed in a Bayesian hierarchical framework using WinBUGS 14.

RESULTS

The results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will summarize all the available data to provide reliable evidence of the value of different doses of azilsartan medoxomil for the treatment of hypertension.

PROSPERO REGISTRATION NUMBER

CRD42019136882.

Drug nanoclusters formed in confined nano-cages of CD-MOF: dramatic enhancement of solubility and bioavailability of azilsartan

Tremendous efforts have been devoted to the enhancement of drug solubility using nanotechnologies, but few of them are capable to produce drug particles with sizes less than a few nanometers. This challenge has been addressed here by using biocompatible versatile γ-cyclodextrin (γ-CD) metal-organic framework (CD-MOF) large molecular cages in which azilsartan (AZL) was successfully confined producing clusters in the nanometer range. This strategy allowed to improve the bioavailability of AZL in Sprague-Dawley rats by 9.7-fold after loading into CD-MOF. The apparent solubility of AZL/CD-MOF was enhanced by 340-fold when compared to the pure drug. Based on molecular modeling, a dual molecular mechanism of nanoclusterization and complexation of AZL inside the CD-MOF cages was proposed, which was confirmed by small angle X-ray scattering (SAXS) and synchrotron radiation-Fourier transform infrared spectroscopy (SR-FTIR) techniques. In a typical cage-like unit of CD-MOF, three molecules of AZL were included by the γ-CD pairs, whilst other three AZL molecules formed a nanocluster inside the 1.7 nm sized cavity surrounded by six γ-CDs. This research demonstrates a dual molecular mechanism of complexation and nanoclusterization in CD-MOF leading to significant improvement in the bioavailability of insoluble drugs.

Antihypertensive effect of azilsartan versus olmesartan in patients with essential hypertension: a meta-analysis

OBJECTIVE

The comparison of antihypertensive effects between azilsartan and olmesartan in patients with essential hypertension has been investigated in several studies. The results were not consistent. We performed this meta-analysis determining the antihypertensive effect of azilsartan versus olmesartan in patients with essential hypertension.

METHODS

Pubmed, Web of Science, and Cochrane Central were searched for all published randomized studies comparing the antihypertensive effects between azilsartan and olmesartan in patients with essential hypertension.

RESULTS

The antihypertensive effects were assessed in 1402 patients included in five trials. The reduction of office systolic blood pressure treated with azilsartan was greater than olmesartan (weighted mean differences (WMD) - 2.15 (95% confidence interval (CI), - 3.78, - 0.53) mm Hg, p < 0.01). There was no significant difference in reduction of office diastolic blood pressure between azilsartan and olmesartan (WMD - 0.99 (95% CI, - 2.06, 0.08) mm Hg, p > 0.05). The reduction of office systolic blood pressure treated with azilsartan was greater than olmesartan at same dose for both drugs (WMD - 2.24 (95% CI, - 4.03, - 0.44) mm Hg, p < 0.05), whereas there was no significant difference in reduction of office diastolic blood pressure between azilsartan and olmesartan (WMD - 0.55 (95% CI, - 1.76, 0.66) mm Hg, p > 0.05).

CONCLUSIONS

This meta-analysis provides the evidence that the reduction of office systolic blood pressure treated with azilsartan was greater than olmesartan in patients with essential hypertension. These findings suggest the importance of strict designed randomized controlled trials in determining antihypertensive effects of angiotensin II receptor blockers in clinical practice.

Azilsartan as "Add-On" Treatment with Methotrexate Improves the Disease Activity of Rheumatoid Arthritis

Objective

The present study aimed to evaluate the efficacy and safety of azilsartan (Azil) as “add-on” treatment with methotrexate (MTX) in patients with active rheumatoid arthritis (RA).

Methods

This single center, randomized, placebo-controlled, double-blind, pilot study included 64 patients with active RA. Patients received either placebo or Azil in addition to their currently used MTX doses for 90 days. The primary outcomes were DAS-28, SDAI, HAQ-DI, CDAI, EGA, and swollen and tender joints count. The secondary outcomes were the changes in the pain visual analogue scale (VAS-100), serum levels of TNF-α, IL-1β, IL-6, and anti-CCP, the lipid profile, and the markers of kidney and liver functions in the two groups at baseline and after 90 days.

Results

After 90 days, most clinical scores were significantly better in the Azil-treated group than in the placebo group. All inflammatory biomarkers were significantly improved after treatment with MTX + Azil compared to baseline and placebo group. No safety concerns were reported during the study period.

Conclusions

Azilsartan improved the effects of methotrexate on the clinical scores and certain inflammatory biomarkers of patients with active RA.

Trial Registration

The protocol was registered under the number 507/SA/1024 at the local clinical studies database, College of Medicine, Sulaimani University.