How long will it take for angiotensin receptor blockers (ARBs) to lower my blood pressure?

Bioavailability and Elimination Half-Life

A 2013 systematic comparison of all clinically used angiotensin receptor blockers (ARBs) found that most ARBs are rapidly absorbed with maximum bioavailability being reached within half an hour to four hours depending on the specific ARB and dose.¹ Elimination half-life ranges from 6 to 24 hours.

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Table 1: ARB maximum bioavailability and elimination half-life¹

Time to Maximal Effect

Most of the antihypertensive effects of azilsartan medoxomil occurs within the first two weeks of dosing.²

Most of the antihypertensive effect of candesartan cilexetil is present within two weeks, and maximal blood pressure reduction is generally obtained within four to six weeks of treatment.³

Maximal blood pressure response to a given dose (ranging from 10 mg to 400 mg) of eprosartan may take two to three weeks of treatment in most patients.⁴

The effect of irbesartan is close to its full observed effect at two weeks.⁵ At the end of an eight-week exposure, about two-thirds of the antihypertensive effect was still present one week after the last dose.

The effect of losartan is substantially present within one week but in some studies the maximal effect occurred in three to six weeks.⁶ In long-term follow-up studies (with no placebo control) the effect of losartan was maintained for up to a year. There is no apparent rebound effect after abrupt withdrawal of losartan. There was essentially no change in average heart rate in losartan-treated patients in controlled trials.

In seven placebo-controlled studies of olmesartan medoxomil at doses ranging from 2.5 mg to 80 mg for 6 to 12 weeks found the onset of antihypertensive effect occurred within one week and was largely manifest after two weeks.⁷

Upon initiation of antihypertensive treatment with telmisartan, blood pressure was reduced after the first dose, with a maximal reduction by about four weeks.⁸ The onset of antihypertensive activity occurs within three hours after administration of a single oral dose. At doses of 20, 40, and 80 mg, the antihypertensive effect of once daily administration of telmisartan is maintained for the full 24-hour dose interval. With automated ambulatory blood pressure monitoring and conventional blood pressure measurements, the 24-hour trough-to-peak ratio for 40 to 80 mg doses of telmisartan was 70% to 100% for both systolic and diastolic blood pressure.

^References

1. Michel MC, Foster C, Brunner HR, Liu L. A systematic comparison of the properties of clinically used angiotensin II type 1 receptor antagonists. Pharmacol Rev 2013; 65 (2): 809-848.
2. Edarbi [package insert] Atlanta, GA: Arbor Pharmaceuticals, LLC; 2016.
3. Atacand [package insert] Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2016.
4. Teveten [package insert]. North Chicago, IL: AbbVie Inc.; 2014.
5. Avapro [package insert] Bridgewater, NJ: Sanofi-Aventis U.S. LLC; 2016.
6. Cozaar [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
7. Benicar [package insert] Parsippany, NJ: Daiichi Sankyo, Inc; 2009.
8. Micardis [package insert] Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc.; 2014.