Evaluation of the safety and efficacy of telmisartan and enalapril, with the potential addition of frusemide, in moderate-renal failure patients with mild-to-moderate hypertension

Abstract

The effect on renal function and efficacy of the angiotensin II AT 1 -receptor blocker (ARB), telmisartan, were compared with those of the angiotensin-converting enzyme inhibitor, enalapril, for the treatment of mild-tomoderate hypertension (diastolic blood pressure [DBP] 95-114 mmHg) in the presence of moderate renal failure (creatinine clearance [Ccr] 30-80 ml/minute). The study was multicentre, double-blind, double-dummy and active-controlled in design, with patients randomised in a 2:1 ratio to receive telmisartan or enalapril. After a two-week placebo run-in period, the 71 eligible patients received either telmisartan, 40 mg, or enalapril, 10 mg, once-daily for four weeks. Thereafter, doses were titrated to telmisartan 80 mg or enalapril 20 mg once-daily if supine trough DBP was still ≥90 mmHg. After a further four weeks, dose titration was again performed, as required, to telmisartan, 80 mg, or enalapril, 20 mg, or frusemide was given in addition if the double dose was already being administered. Mean Ccr decreases of 4.6% for telmisartan and 2.8% for enalapril were not clinically significant. Adverse events occurred in 12 (26.7%) telmisartan-treated patients and in 12 (46.2%) patients receiving enalapril. The mean reduction in supine trough DBP from baseline to the last available value was 12.5 mmHg for telmisartan, compared with 11.9 mmHg for enalapril. A full (reduction of ≥10 mmHg) or partial (reduction of 7-9 mmHg) response occurred in 78% of telmisartan patients and 65% of enalapril patients. In the enalapril group, 43% of patients required frusemide, compared with 29% of those in the telmisartan group. In conclusion, telmisartan lacks detrimental effect on renal function, is effective in the treatment of mild-to-moderate hypertension in patients with moderate renal failure, and is comparable to enalapril.

ABPM Comparison of the Anti-Hypertensive Profiles of Telmisartan and Enalapril in Patients with Mild-to-Moderate Essential Hypertension

“…The results of this study confirm those from previous studies in which telmisartan and enalapril provided comparable blood pressure control in a broad range of hypertensive patients, namely those with mild-to-moderate or severe disease, 15,18,19 concomitant renal disease, 20 a history of ACE inhibitor-induced cough, 16 and the elderly. 17 Enalapril was chosen as the ACE inhibitor for comparison with telmisartan in this 24-h ABPM study for several reasons.…”

New standards in hypertension and cardiovascular risk management: focus on telmisartan

“…Other studies confirmed that telmisartan reduced macroalbuminuria in patients with mild and moderate renal failure 104,105. The effects of telmisartan on proteinuria may well be additive to those of ACE inhibitors 106…”

Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials

“…15 Telmisartan versus enalapril Thirteen trials involving 1682 patients compared telmisartan with enalapril. 5,[15][16][17][18][19][20][21][22][23][24][25][26] There was a greater reduction in both DBP and SBP with the use of telmisartan as compared with enalapril. Therapeutic response rates of DBP and SBP favored telmisartan (RR 1.15, 95% confidence interval (CI) 1.05-1.26; RR 1.18, 95% CI 1.02-1.38, respectively).…”