ABPM comparison of the antihypertensive profiles of the selective angiotensin II receptor antagonists telmisartan and losartan in patients with mild-to-moderate hypertension

Abstract

The antihypertensive efficacy and tolerability profiles of the selective AT1 receptor antagonists telmisartan and losartan were compared with placebo in a 6-week, multinational, multicentre, randomised, double-blind, double-dummy, parallel-group study of 223 patients with mild-to-moderate hypertension, defined as clinic diastolic blood pressure (DBP) >/=95 and </=114 mm Hg, clinic systolic blood pressure (SBP) >/=140 and </=200 mm Hg, and 24-h ambulatory DBP >/=85 mm Hg. After a 4-week single-blind placebo run-in, eligible patients were randomised to receive telmisartan 40 mg, telmisartan 80 mg, losartan 50 mg, or placebo. Ambulatory blood pressure monitoring (ABPM) after 6 weeks of double-blind therapy showed that all active treatments produced significant (P < 0.01) reductions from baseline in 24-h mean SBP and DBP compared with placebo. During the 18-to-24 h period after dosing, the reductions in SBP/DBP with telmisartan 40 mg (10.7/6.8 mm Hg) and 80 mg (12.2/7. 1 mm Hg) were each significantly (P <0.05) greater than those observed for losartan 50 mg (6.0/3.7 mm Hg), and losartan was no better than placebo. Also for the 24-h mean blood pressure, telmisartan 40 mg and 80 mg were significantly (P< 0.05) better than losartan 50 mg. Compared with losartan, telmisartan 80 mg produced significantly (P < 0.05) greater reductions in both SBP and DBP during all monitored periods of the 24-h period, while telmisartan 40 mg produced significantly greater reductions in SBP and DBP in the night-time period (10.01 pm to 5.59 am) (P < 0.05) and in DBP in the morning period (6.00 am to 11.59 am) (P < 0.05). All treatments were comparably well tolerated. Telmisartan 40 mg and 80 mg once daily were effective and well tolerated in the treatment of mild-to-moderate hypertension, producing sustained 24-h blood pressure control which compared favourably with losartan.

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

“…Telmisartan administered in single daily doses of 40 and 80 mg was superior to placebo, losartan 50 mg/day, valsartan 80 mg/day and amlodipine 5 mg/day in lowering the systolic blood pressure (SBP) and diastolic blood pressure (DBP) and preventing their early morning rise as illustrated in Figure 6a and b for the SBP and DBP, respectively. 44,45 In another double-blind, 46 In other short-term studies, telmisartan was as effective or better than atenolol, 47 enalapril 48 and lisinopril. 49 Telmisartan has also been combined with a low-dose diuretic for better blood pressure control.…”

AT1-receptor blockers: differences that matter

“…Significant reductions in both systolic and diastolic blood pressure were seen 48 h after dosing with candesartan, whereas in losartantreated patients blood pressures were not significantly different from baseline values at this time ( Figure 6). Indeed, the effect on blood pressure seen 48 h after dosing with candesartan was comparable with that seen with losartan after 24 h. Similar results were obtained in a second study with ambulatory blood pressure monitoring, in which the antihypertensive effect over 36 h of candesartan cilexetil, 8 mg, was significantly greater than that of losartan, 50 mg. 31 Other studies have shown that irbesartan, 150 mg, and telmisartan, 40-80 mg, appear to have greater effects on ambulatory blood pressure than valsartan, 80 mg, or losartan, 50 mg. [32][33][34][35][36] The available studies thus indicate that the therapeutic effect of candesartan is maintained even if a dose is delayed or missed, and hence candesartan offers extended therapeutic coverage. The potential importance of this extended therapeutic coverage is underlined by studies of adherence with antihypertensive medication.…”

Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy

“…[10][11][12][13][14][15] Hydrochlorothiazide (HCTZ) is a benzothiadiazide diuretic; these agents lower blood pressure through alteration of the sodium balance. HCTZ also augments the therapeutic response to some other classes of antihypertensive agents.…”