We won’t talk too much about valsartan here because given the ongoing FDA investigations, folks taking valsartan should be switched to another ARB drug. So, we’re now choosing between losartan, olmesartan, and telmisartan. Which one is best? Here’s what you should know.
Losartan
Upsides:
- Losartan (Diovan) was the first ARB to ever be approved, so it has the longest track record of success.
- Losartan is available as a very affordable generic.
- Losartan is made as a stand-alone drug, and in a combination tablet with the diuretic, hydrochlorothiazide (HCTZ), as losartan/HCTZ. Convenient.
Downsides:
- Losartan is taken once daily, though at lower strengths it doesn’t provide great 24-hour coverage. Losartan 25 mg or 50 mg once daily may not give you full coverage throughout the day and night. Drat.
- Losartan doesn’t appear to work as well as olmesartan or telmisartan at lowering diastolic blood pressure (the second number in your blood pressure reading). Olmesartan and telmisartan win over losartan in terms of lowering blood pressure.
Olmesartan
Upsides:
- Olmesartan was approved in 2002 as brand-name Benicar, but is now available as a cheaper generic.
- Olmesartan is available in convenient combination tablets: olmesartan/HCTZ and olmesartan/amlodipine/HCTZ.
- Olmesartan is better than losartan at lowering blood pressure and generally provides good 24-hour coverage. Looking good. Read on.
- Olmesartan provides a bonus benefit in that it lowers cholesterol levels on top of lowering blood pressure—as does telmisartan.
Downsides:
- Taking olmesartan comes with a very small risk of “sprue-like enteropathy”, characterized by bouts of diarrhea and weight loss that go away when you stop taking it. The risk, again, is very small (1 in every 12,550 people treated), but if you do develop these symptoms, stop using the medication.
- Olmesartan is most likely not the preferred ARB on your insurance plan. But with a GoodRx coupon, a typically monthly supply can be as low as $12.
Telmisartan
Upsides:
- Telmisartan, also available as brand-name Micardis, has better 24-hour coverage than losartan.
- Like the other ARBs, telmisartan comes in convenient combination tablets: telmisartan/HCTZ and telmisartan/amlodipine.
- Telmisartan is equally as effective as olmesartan at lowering blood pressure.
- On top of lowering blood pressure, telmisartan provides two other benefits: lowering blood sugar levels (by improving insulin sensitivity) and lowering cholesterol levels. The added blood sugar benefit sets telmisartan apart from olmesartan and losartan.
- Both telmisartan and olmesartan lower cholesterol levels, but compared to olmesartan, telmisartan is better at lowering LDL (“bad”) cholesterol levels. So, there’s that.
Downsides:
- Telmisartan is often not the preferred ARB on insurance plans. But, since telmisartan is available as a generic, its cash price is affordable.
What about their side effects?
In head-to-head studies, patients generally tolerated the side effects of telmisartan, olmesartan, and losartan fairly well. The most commonly reported side effects—dizziness and headaches—occurred at the same frequency (5% of patients) regardless of which drug was taken.
To sum it up: Olmesartan and telmisartan are equally effective at reducing blood pressure, whereas losartan is less effective. Telmisartan is best in terms of cholesterol-lowering effects. And among the three, only telmisartan has a blood sugar-lowering effect.
So, there you have it.
Dr O.
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