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

Abstract

Telmisartan and angiotensin-converting enzyme inhibitors (ACEIs) are both effective and widely used antihypertensive drugs targeting renin-angiotensinaldosterone system. The study aimed to estimate the efficacy and tolerability of telmisartan in comparison with different ACEIs as monotherapy in the treatment of hypertension. Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. A random-effect model was used to account for heterogeneity among trials. Twenty-eight randomized controlled trials involving 5157 patients were ultimately identified out of 721 studies. Telmisartan had a greater diastolic blood pressure (DBP) reduction than enalapril (weighted mean difference (WMD) 1.82, 95% confidence interval (CI) 0.66-2.99), ramipril (WMD 3.09, 95% CI 1.94-4.25) and perindopril (WMD 1.48, 95% CI 0.33-2.62). Telmisartan also showed a greater DBP response rate than enalapril (relative risk (RR) 1.15, 95% CI 1.05-1.26), ramipril (RR 1.34, 95% CI 1.11-1.61) and perindopril (RR 1.22, 95% CI 1.05-1.41). There was no statistical difference in DBP reduction or therapeutic response rate between telmisartan and lisinopril (WMD À0.30, 95% CI À0.65 to 0.05; RR 0.99, 95% CI 0.80-1.23, respectively). Telmisartan had fewer drug-related adverse events than enalapril (RR 0.57, 95% CI 0.44-0.74), ramipril (RR 0.44, 95% CI 0.26-0.75), lisinopril (RR 0.70, 95% CI 0.56-0.89) and perindopril (RR 0.52, 95% CI 0.28-0.98). The meta-analysis indicates that telmisartan provides a superior BP control to ACEIs (enalapril, ramipril and perindopril) and has fewer drug-related adverse events and better tolerability in hypertensive patients.

Double Blind Randomised Comparative Study of Efficacy and Tolerability of Telmisartan and Lisinopril in Male Patients of Stage 1 Essential Hypertension

“…23 The present study showed that both telmisartan and lisinopril are effective drugs in reducing both systolic and diastolic blood pressure throughout study period when measured at the 2 nd , 4 th , 8 th , 10 th , and 12 th week. When efficacy of telmisartan is compared with lisinopril, it showed that there was no statistical difference in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) reduction between telmisartan and lisinopril.…”

“…However, in lisinopril treated group the incidence of dry cough was significantly higher compared to telmisartan group (P<0.05). 21,22,23 …”

Are the Pleiotropic Effects of Telmisartan Clinically Relevant?

“…A recent meta-analysis compared the efficacy of telmisartan vs various ACE-Is (ramipril, enalapril, perindopril and lisinopril) [14]. Overall, telmisartan was significantly superior to ramipril, enalapril and perindopril in reducing both systolic and diastolic BP.…”

Comparative study of efficacy and adverse effects profile of telmisartan vs enalapril maleate in patients of essential hypertension and diabetic hypertensives

“…Control to enalapril and better tolerability in hypertensive patients. 4 JH Chen studied 147 patients of Taiwanese, mild to moderate essential hypertensives on telmisartan -40mg, enalapril -10mg once daily. Treatment period was 6 weeks.…”