A multicenter, open-label study of the efficacy and safety of telmisartan in mild to moderate hypertensive patients

Abstract

Objective -The ideal antihypertensive agent must have the following profile: it must promote effective blood pressure (BP) reduction, maintain blood pressure control over 24 hours with a single daily dose, be as effective as possible for a great number of hypertensive patients, cause no undesirable side effects have no negative effects on metabolic parameters 1 , and finally be reasonably affordable. None of the antihypertensive agents currently available have all of these characteristics. More recently, some new drugs have demonstrated some of the desired characteristics of an ideal drug.The maintenance of blood pressure reduction during the first hours of the morning, after the patient wakes up, is another major point to be considered, because the most likely peak time for cardiovascular events occurs between 06:00-11:00 2-5 . The goals for blood pressure levels have become increasingly rigorous. The new goals are based on the results from the most recent prospective clinical studies, such as HOT 6 and UKPDS 7 , which demonstrate that more rigorous blood pressure control provides greater protection against cardiovascular morbidity and mortality in hypertensive populations. These findings emphasize that antihypertensive agents must keep blood pressure under control for the longest period of time possible.The renin-angiotensin system (RAS) plays an important role in the pathogenesis and maintenance of the mechanisms involved in the development of essential hypertension. Some of its actions have been well characterized 8 . Briefly, angiotensin II (AII) acts by binding to its specific subtype AT 1 receptor, leading to vasoconstriction, increasing peripheral resistance (raising blood pressure levels), and promoting some trophic actions (wall and heart vessels hypertrophy).A new class of antihypertensive agents, the angiotensin II (AII) antagonist receptors (AIIAR) (ie, losartan, valsartan, irbesartan, candesartan, and telmisartan), blocks the binding of AII to its subclass receptor AT 1 . This action prevents the potent vasoconstriction generated by AII.

A Prospective, Randomized Open-Label Study for Assessment of Antihypertensive Effect of Telmisartan Versus Cilnidipine Using Ambulatory Blood Pressure Monitoring (START ABPM Study)

“…The effectiveness of the treatment over different time durations could be explored through continuous monitoring, which was the value addition of the study as compared to manual office measurements. The overall profile of BP in both treatment groups was similar to that reported by Plavnik et al in 2002 [ 16 ]. In general, both hypertensive and normotensive individuals have similar circadian variation in BP, with higher values during the daytime and lower during the night times [ 17 ].…”

The effect of Ramipril and Telmisartan on blood pressure and insulin resistance in hypertensive patients

“…Plavnik et al reported a mean fall to be 14.4 mmHg for SBP and 10.3 mmHg for DBP (p<0.05) after 12 weeks of Telmisartan treatment. 7 However, in this study, Telmisartan 40 mg/daily was given for 6 weeks. In those patients whose blood pressure BP levels were lower than 140/90 mmHg, the same dosage was kept for an additional period of 6 weeks.…”

“…6 Among the antihypertensive drugs beta blockers and diuretics (thiazides and loop diuretics) can themselves cause hyperglycemia and impair lipid profile, but ARB's and ACE inhibitors have rather shown a modest positive effect on lipid profile and insulin resistance; also both the ACE inhibitors and ARBs have been compared with a placebo for their anti-hypertensive effects but there are very few studies where they have been compared with each other so, the present study was undertaken to study the effect of ramipril and telmisartan on blood pressure and insulin resistance in hypertensive patients. 7…”