Meta-analysis of Randomized Controlled Trials Comparing Telmisartan With Losartan in the Treatment of Patients With Hypertension

Xi, Gui-Lin; Cheng, Jin-Wei; L, Gao

doi:10.1038/ajh.2008.30

Cited by 25 publications

(13 citation statements)

References 23 publications

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“…35 Importantly, accumulated evidence indicated that telmisartan has a longer half-life, and thus a longer duration of action, than does losartan. 36 For example, a previous comparison of the antihypertensive profiles of telmisartan and losartan on ambulatory BP disclosed that telmisartan 40 mg once daily produced a significantly greater BP reduction, particularly during nighttime, than did losartan 50 mg once daily in patients with mild-to-moderate hypertension, 37 and other studies reported that the BP-lowering effects of telmisartan were stronger than those of losartan in the morning and during the last 6 h of the 24-h dosing interval. 38,39 Therefore, although we have not directly examined the effects of losartan and telmisartan on morning BP profile, including morning BP surge and on possible relationships between morning BP and urinary protein excretion in this study, the beneficial effect of telmisartan on reducing proteinuria should be, at least partly, because of a longer half-life and more potent action on nighttime BP lowering at a once-daily dose.…”

Section: Discussionmentioning

confidence: 99%

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

et al. 2009

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Previous studies have shown increases in ambulatory short-term blood pressure (BP) variability to be related to cardiovascular disease. In this study, we examined whether the angiotensin II type 1 receptor blocker (ARB) would improve ambulatory shortterm BP variability in hypertensive patients with diabetic nephropathy. A total of 30 patients with type II diabetes, along with hypertension and overt nephropathy, were enrolled in this randomized, two-period, crossover trial of 12 weeks of treatment with losartan (50 mg daily) and telmisartan (40 mg daily). At baseline and at the end of each treatment period, 24-h ambulatory BP monitoring with power spectral analysis of heart rate and measurements of proteinuria, estimated glomerular filtration rate and brachial-ankle pulse wave velocity (baPWV) were performed. After 12 weeks of treatment, 24-h, daytime and nighttime shortterm BP variability, assessed on the basis of the coefficient of variation of ambulatory BP, was significantly decreased by telmisartan. Both losartan and telmisartan reduced urinary protein excretion and baPWV. However, compared with losartan, telmisartan significantly decreased urinary protein excretion, baPWV and low-frequency (LF)-to-high-frequency (HF) ratio, an index of sympathovagal balance. Multiple regression analysis showed significant correlations between urinary protein excretion and baPWV, 24-h LF-to-HF ratio, nighttime systolic BP and 24-h short-term systolic BP variability. These results suggest that ARB, particularly telmisartan, is effective in reducing proteinuria in hypertensive patients with overt diabetic nephropathy, partly through inhibitory effects on ambulatory short-term BP variability and sympathetic nerve activity, in addition to its longer duration of action on nighttime BP reduction.

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Section: Discussionmentioning

confidence: 99%

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

et al. 2009

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“…19,20 In addition, telmisartan may be clinically more effective than losartan in lowering blood pressure in hypertensive patients. 21 On the other hand, telmisartan can activate PPARg partly due to its highly lipophilic nature 22 and its ability to bind to the PPARg ligand-binding domain. 17 This unique nature of being a dual ARB/PPARg agonist makes telmisartan a more promising drug in treating cardiovascular diseases in a safer manner.…”

Section: Introductionmentioning

confidence: 99%

Telmisartan inhibits vasoconstriction via PPARγ-dependent expression and activation of endothelial nitric oxide synthase

Yuen

Wong

Tian

et al. 2010

Cardiovascular Research

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“…12 Randomized controlled studies compared the effect of telmisartan with losartan, and the use of telmisartan resulted in a significant reduction in clinic SBP and DBP when compared with losartan by meta-analysis. 37 Vitale et al 38 investigated the metabolic effects of 80 mg per day telmisartan or 50 mg per day losartan treatment for 3 months in Italian hypertensive MetS patients and found significant decreases in insulin, HOMA index and HbA1c levels in the telmisartan treatment group but not in the Effects of telmisartan and losartan in hypertensive patients H Hasegawa et al losartan group. The study demonstrated a significant decrease in 24-hour mean BP in both treatment groups, but telmisartan led to larger reductions in SBP and DBP as compared with losartan.…”

Section: Discussionmentioning

confidence: 99%

Effects of telmisartan and losartan on cardiovascular protection in Japanese hypertensive patients

et al. 2011

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The Telmisartan and Losartan Cardiac Evaluation Trial, a multicenter, prospective, randomized, open-labeled, blinded-endpoint trial, was designed to compare the effects of two angiotensin II receptor blockers (ARBs), telmisartan and losartan, on cardiovascular protection in Japanese patients with mild to moderate essential hypertension. We compared the effects of telmisartan and losartan on left ventricular (LV) hypertrophy, cardiac function, atherosclerosis of carotid arteries and surrogate markers related to the actions of peroxisome proliferator-activated receptor-c. A total of 58 patients were enrolled in the present trial and the follow-up period was 1 year. There were no significant differences in blood pressure (BP) levels between the telmisartan group and the losartan group throughout the trial. The percentage of the patients treated with ARB monotherapy was significantly higher in the telmisartan group compared with the losartan group. In addition, the progression of intima-media thickness of common carotid artery was significantly inhibited in the telmisartan group compared with the losartan group. Neither group experienced significant changes in cardiac function and LV mass index. There were no differences between the groups with respect to changes in surrogate markers such as serum adiponectin, creatinine, homeostasis model assessment index, plasminogen activator inhibitor-1 and high sensitivity C-reactive protein. Although BP levels were equal and well controlled in both groups, telmisartan showed more protective vascular effects than losartan.

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Meta-analysis of Randomized Controlled Trials Comparing Telmisartan With Losartan in the Treatment of Patients With Hypertension

Abstract: In comparison with losartan, telmisartan provides superior control of BP and has no association with increased risk of adverse events.

Cited by 25 publications

References 23 publications

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy

Telmisartan inhibits vasoconstriction via PPARγ-dependent expression and activation of endothelial nitric oxide synthase

Effects of telmisartan and losartan on cardiovascular protection in Japanese hypertensive patients

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