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

Figures & data

Figure 1 Mechanism of blockade of the renin–angiotensin system.

Abbreviations: SNS, somatic nervous system; tPA, tissue plasminogen activator.

Table 1 Summary of studies comparing the antihypertensive efficacy of telmisartan

References	Duration	No of pts	Active comparators	Baseline in-clinic seated SBP/DBP (mmHg)	SBP/DBP reduction at study endpoint (mmHg)	Response rate (% pts)
Versus other ARBs
Nishimura et al^Citation33	4 weeks	72	Telmisartan (T) 10–40 mg od Losartan (L) 25–100 mg od Candesartan (C) 2–12 mg od Valsartan (V) 40–80 mg od	Baseline values not stated in paper. Patients had home morning and evening SBP and/or DBP of < 180 and ≥ 135 mmHg and < 120 and ≥ 85 mmHg, respectively	Home evening SBP/DBP:   T: −24.7/−15.1*   L: −15.7/−11.4   C: −15.9/−11.6   V: −21.8/−11.4 Home morning SBP/DBP:   T: −21.9/−12.5*   L: −7.9/−3.0   C: −11.4/−11.0   V: −17.0/−9.5
White et al^Citation34	8 weeks	490	Telmisartan 80 mg od Valsartan 160 mg od	T: 154.0/99.0 V: 153.0/99.0	Last 6 h:   T: −11.0/−7.6*   V: −8.7/−5.8 After missed dose:   T: −10.3/−6.9 (24 h)   V: −8.7/−5.9 (24 h)
Lacourcière et al^Citation35	8 weeks	930	Telmisartan 40–80 mg od Valsartan 80–160 mg od	T: 157.3/100.1 V: 156.0/100.0	Last 6 h:   T: −11.1/−7.6*   V: −9.1/−5.8 After missed dose:   T: −10.7/−7.2 (24 h)*   V: −8.7/−5.5 (24 h)
Mallion et al^Citation36	6 weeks	223	Telmisartan 40–80 mg od Losartan 50 mg od	T 40 mg: 161.9/100.8 T 80 mg: 164.2/101.8 L: 162.4/100.7	Daytime:   T 40 mg: −11.5/−7.3*   T 80 mg: −13.3/−8.3*   L: −8.7/−5.3 Night-time:   T 40 mg: −11.5/−7.6*   T 80 mg: −13.1/−8.2*   L: −7.0/−4.5 Morning:   T 40 mg: −10.6/−6.8*   T 80 mg: −12.8/−7.7*   L: −7.8/−4.3	SBP response (≥ 10 mmHg change from baseline):   T 40 mg: 56.1   T 80 mg: 69.8*   L: 45.6 DBP response (< 90 mmHg and/or ≥ 10 mmHg change from baseline):   T 40 mg: 40.4   T 80 mg: 52.8*   L: 29.8
Smith et al^Citation37	8 weeks	720	Telmisartan 40–80 mg od Losartan 50–100 mg od	Baseline BP not given in paper. Patients included in study had mild-moderate hypertension (seated DBP 95–109 mmHg)	Last 6 h:   T: −9.9/−6.6*   L: −7.8/−5.1	SBP response (<140 mmHg and/or ≥ 10 mmHg change from baseline):   T: 62.3   L: 56.6 DBP response (< 90 mmHg and/or ≥ 10 mmHg change from baseline):   T: 45.0   L: 41.1
Ding et al^Citation38	6 weeks	61	Telmisartan 40 mg od Losartan 50 mg od	T:153.6/101.1 L: 154.5/99.1	18–24 h:   T: −16.0/−12.1*   L: −11.8/−7.0	SBP response (< 140 mmHg or ≥ 10 mmHg reduction from baseline):   T: 90.3   L: 92.0 DBP response (<90 mmHg or ≥ 10 mmHg reduction from baseline):   T: 77.4   L: 72.0
Derosa et al^Citation39	52 weeks	119	Telmisartan 40 mg od Eprosartan (E) 600 mg od	T: 143.0/92.0 E: 144.0/91.0	After 12 months:   T: −8.0/−8.0   E: −7.0/−4.0
Nakayama et al^Citation40	2 × 8 weeks (treatment switch)	20	Telmisartan 40 mg od Olmesartan (O) 20 mg od	Patients at baseline treated with valsartan then switched to telmisartan or olmesartan. Baseline SBP/DBP: 133.6/75.5	Mean 24 h:   T: −0.9/+1.8   O: −4.2/−0.9* Daytime:   T: −3.4/+1.3   O: −5.6/−1.9* Night-time:   T: +3.5/+4.0   O: −1.9/+0.7*
Sasaki et al^Citation41	2 × 3 months (treatment switch)	20	Telmisartan 40 mg od Olmesartan 20 mg od	Pre-treatment:   129.9/73.2	In-clinic:   T: −0.4/−0.5   O: −1.1/−0.6 Home morning:   T: −0.0/+0.3*   O: +1.9/+1.6 Home evening:   T: −0.3/−0.5   O: −0.3/−1.1
Versus ACE inhibitors
Williams et al^Citation42	14 weeks	801	Telmisartan 80 mg od Ramipril (R) 5–10 mg od	T: 158.5/100.1 R: 158.3/100.1	Last 6 h:   T: −12.1/−8.5*   R 10 mg: −8.4/−5.8 Mean 24 h:   T: −14.5/−9.8*   R 10 mg: −11.6/−7.7	SBP/DBP response (<130/80 mmHg or ≥10 mmHg reduction from baseline):   T: 76.2//61.9*   R: 66.9/54.8
Lacourcière et al^Citation43	14 weeks	812	Telmisartan 40–80 mg od Ramipril 2.5–10 mg od	T: 153.9/99.7 R: 152.5/99.8	Last 6 h:   T: −12.7/−8.8* R 10 mg: −7.9/−5.4 Mean 24 h:   T: −14.8/−9.9*   R 10 mg: −10.7/6.7	SBP/DBP response (<130/80 mmHg and/or ≥ 10 mmHg reduction from baseline):   T: 70.7/60.5*   R: 62.7/46.8
Gosse et al^Citation44	14 week	1613	Telmisartan 40–80 mg od Ramipril 2.5–10 mg od	T: 156.1/99.9 R: 155.1/100.0	Mean 24 h:   T: −14.0/−9.6*   R 10 mg: −11.1/−7.2 Early morning:   T: −12.7/−8.5*   R 10 mg: −7.9/−5.2 Night-time:   T: −11.0/−8.5*   R 10 mg: −8.4/−5.9
Nalbantgil et al^Citation46	6 weeks	60	Telmisartan 80 mg od Perindopril (P) 4 mg od	T: 167.4/102.2 P: 167.6/101.4	In-clinic:   T: −27.7/−12.4   P: −25.9/−10.1 Mean 24 h	DBP response (≤85 mmHg):   T: 66.6*   P: 46.6
Ragot et al^Citation47	12 weeks	441	Telmisartan 40 mg od Perindopril 4 mg od	T: 158.0/98.0 P: 159.0/98.0	Mean between-treatment difference in in-clinic SBP/DBP:   −3.4/−2.5* (in favor of telmisartan)	SBP/DBP normalization rate (<135/<85 mmHg):   T: 46/58*   P: 32/46
Stergiou et al^Citation48	5 weeks	36	Telmisartan 80 mg od Lis (L) 20 mg od	T: 134.2/88.2 L: 134.3/87.5	Mean 24 h:   T: −7.7/−7.1   L: −9.0/−7.1
Neutel et al^Citation49	52 weeks	578	Telmisartan 40–160 mg od Lis 10–40 mg od	T: 153.4/100.8 L: 152.5/100.5	In-clinic:   T: −21.1/−16.3   L: −19.3/−15.4
Versus β-blockers
Freytag et al^Citation51	26 week	533	Telmisartan 40–120 mg od Atenolol (A) 50–100 mg od	T: 166.5/102.0 A: 164.5/101.4	In-clinic:   T: −20.9/−14.4*   A: −16.7/−13.3	DBP response (≤90 mmHg and/or ≥10 mmHg change from baseline):   T: 84   A: 78
Alcocer et al^Citation52	8 weeks	58	Telmisartan 80 mg od Atenolol 50 mg od	T: 158.4/99.2 A: 153.8/97.9	In-clinic:   T: −20.4/−13.0*   A: −9.1/−8.6
Galzerano et al^Citation53	44 weeks	82	Telmisartan 80 mg od Carvedilol (C) 25 mg od	T: 159.6/97.8 C: 157.8/95.7	Mean 24 h:   T: −31.0/−19.6   C: −29.6/−17.0
Versus CCBs
Lacourcière et al^Citation54	12 weeks	232	Telmisartan 40–120 mg od Amlodipine 5–10 mg od	Baseline BP not stated in paper. Patients included in study had mild-moderate hypertension (seated DBP 95–114 mmHg)	In-clinic:   T: −16.5/−11.6   A: −17.4/−11.6 Night-time and last 4 h:   Significantly greater DBP reductions with telmisartan vs amlodipine (values not provided)	DBP response (24-h DBP <85 mmHg or ≥ 10 mmHg change from baseline):   T: 81   A: 66
Derosa et al^Citation55	12 month	116	Telmisartan 40 mg od Nifedipine (N) GITS 20 mg	T: 139.0/95.0 N: 140.0/94.0	In-clinic:   T: −7.0/−9.0   N: −10/−10
Versus HCTZ
McGill, Reilly^Citation56	8 weeks	818	Telmisartan 20–160 mg od HCTZ (H) 6.25–25 mg od	T: 153.2/100.7 H: 153.3/100.7	In-clinic:   T 40 mg: −12.2/−10.7   T 80 mg: −15.4/−11.5   H 12.5 mg: −6.9/−7.3	SBP response (≥ 10 mmHg change from baseline):   T 40 mg: 60   T 80 mg: 66   H 12.5 mg: 36 DBP response (≤90 mmHg and/or ≥10 mmHg change from baseline):   T 40 mg: 67   T 80 mg: 69   H 12.5 mg: 47
Galzerano et al^Citation57	12 months	69	Telmisartan 80 mg od HCTZ 25 mg od	T: 157.0/96.0 H: 154.0/95.0	Mean 24 h:   T: −24.0/−13.0*   H: −10.0/−8.0	DBP < 90 mmHg or reduction in both SBP and DBP of ≥ 10 mmHg:   T: 74   H: 56
Manolis et al^Citation58	2–4 weeks	1039	Telmisartan 20–80 mg od HCTZ 12.5 mg od	T 20 mg: 163.5/83.7 T 40 mg: 162.7/83.4 T 80 mg: 162.4/83.2 H: 162.5/83.5	In-clinic:   T 20 mg: −4.2/−2.4   T 40 mg: −6.5/−3.3   T 80 mg: −5.6/−3.0   H: −15.7/−1.9
Combination treatment
McGill, Reilly^Citation56	8 weeks	818	Telmisartan 20–160 mg od plus HCTZ 6.25–25 mg od	T + H: 154.5/100.7	In-clinic:   T 40 mg + H: −18.8/−12.6**   T 80 mg + H: −23.9/−14.9**	SBP response (≥10 mmHg change from baseline):   T 40 mg + H: 81   T 80 mg + H: 85** DBP response (≤90 mmHg and/or ≥ 10 mmHg change from baseline):   T 40 mg + H: 63   T 80 mg + H: 79**
Lacourcière et al^Citation59	6 weeks	1402	Telmisartan 40–80 mg plus HCTZ 12.5 mg od Losartan 50 mg plus HCTZ 12.5 mg od	T 40 mg + H: 155.0/100.0 T 80 mg + H: 156.5/100.2 L 50 mg + H: 155.2/99.8	Last 6 h:   T 40 mg + H: −17.2/−11.3*   T 80 mg + H: −18.0/−12.0*   L 50 mg + H: −14.6/−9.4 In-clinic:   T 40 mg + H: −16.8/−11.3*   T 80 mg + H: −18.5/−12.3*   L 50 mg + H: −14.0/–8.7	SBP response (<130 mmHg and/or ≥10 mmHg reduction from baseline):   T 40 mg + H: 79.1*   T 80 mg + H: 82.3*   L 50 mg + H: 76.7 DBP response (24-h mean DBP <85 mmHg or ≥ 10 mmHg reduction from baseline):   T 40 mg + H: 60.3*   T 80 mg + H: 69.4*   L 50 mg + H: 55.0
White et al^Citation60	8 weeks	1109	Telmisartan 80 mg plus HCTZ 25 mg od Valsartan 160 mg plus HCTZ 25 mg od	T + H: 154.6/101.8 V + H: 154.3/101.9	In-clinic:   T + H: −23.6/−17.5*   V + H: −20.9/−16.1
White et al^Citation61	8 weeks	1185	Telmisartan 80 mg plus HCTZ 25 mg od Valsartan 160 mg plus HCTZ od	T + H: 154.1/101.8 V + H: 154.9/101.6	In-clinic:   T + H: −24.6/−18.2*   V + H: −22.5/−17.0*
Fogari et al^Citation62	16 weeks	145	Telmisartan 80 mg plus HCTZ 12.5 mg od Olmesartan 20 mg plus HCTZ 12.5 mg od	T + H: 169.7/103.7 O + H: 169.1/104.1	Mean 24 h:   T + H: −20.8/−14.3*   O + H: −17.7/−11.3 Daytime:   T + H: −21.0/−12.9*   O + H: −18.7/−11.7 Night-time:   T + H: −21.1/−14.3*   O + H: −16.7/−10.0
Lacourcière et al^Citation63	8 weeks	491	Telmisartan 80 mg plus HCTZ 12.5 mg od Telmisartan 80 mg od	T + H: 148.9/96.4 T: 148.7/96.6	In-clinic:   T + H: −12.6/−8.0*   T: −7.0/−4.9	Normalized SBP/DBP response (<140/90 mmHg):   T + H: 41.5*   T: 26.1 DBP response (DBP < 90 mmHg):   T + H: 52.4*   T: 35.5
Sharma et al^Citation64	10 weeks	840	Telmisartan 80 mg plus HCTZ 12.5 mg od Valsartan 160 mg plus HCTZ 12.5 mg od	T + H: 156.8/92.1 V + H: 157.1/91.7	Last 6 h:   T + H: −18.4/−9.7*   V + H: −14.5/−77	SBP response (24-h mean SBP < 130 mmHg and/or ≥ 10 mmHg reduction):   T + H: 79.9   V + H: 75.6 DBP response (24-h mean DBP < 90 mmHg and/or ≥ 10 mmHg reduction):   T + H: 79.9   V + H: 77.3
Neldam, Edwards^Citation65	14 weeks	1000	Telmisartan 80 mg plus HCTZ 12.5 mg od Amlodipine (Am) 10 mg plus HCTZ 12.5 mg od	T + H: 161.0/87.3 Am + H: 161.7/86.8	SBP during last 6 h:   T + H: −18.3   Am + H: −17.4	SBP response (24-h mean SBP < 130 mmHg and/or ≥ 10 mmHg reduction from baseline):   T + H: 86.4   Am + H: 85.1
Schumacher, Mancia^Citation66	7 days to 2 years	8023	Telmisartan 10–160 mg plus HCTZ 6.25–25 mg od Telmisartan 10–160 mg od	T + H: 157.6/101.4 T: 158.3/98.7	In-clinic:   T + H: −21.1/−14.2   T: −13.8/−8.7
Littlejohn et al^Citation67	8 weeks	1461	Telmisartan 20–80 mg plus amlodipine 2.5–10 mg od Telmisartan 20–80 mg od Amlodipine 2.5–10 mg od	Overall: 153.2/101.7	In-clinic:   T 80 mg + Am 10 mg:   −26.4/−20.1**   T 80 mg: −14.3/−14.0   Am 10 mg: −20.7/−17.1	DPB response (<90 mmHg or ≥10 mmHg reduction from baseline):   T 80 mg + Am 10 mg: 91.2   T 80 mg: 78.0   Am 10 mg: 85.5 SBP response (<140 mmHg or ≥ 15 mmHg reduction from baseline):   T 80 mg + Am 10 mg: 90.4   T 80 mg: 65.2   Am 10 mg: 82.3

* P < 0.05 vs active comparator;

** P < 0.05 vs respective monotherapies.

Abbreviations: ACE, angiotension-converting enzyme; ARB, angiotensin II receptor blocker; CCBs, calcium channel blockers; HCTZ, hydrochlorothiazide, once daily.

Figure 2 The cardiovascular and renal continua of disease and studies evaluating the efficacy of telmisartan.

Abbreviations: ARB, angiotension II receptor blocker; FDC, fixed-dose combination; LVH, left ventricular hypertrophy.

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