Effects of telmisartan on office and 24-hour ambulatory blood pressure: an observational study in hypertensive patients managed in primary care

Figures & data

Table 1 Baseline data for 100 hypertensive patients completing 8 weeks of treatment with telmisartan with or without HCT

	Total cohort	Treatment-naïve	1 BP drug	2 BP drugs	3 BP drugs	4 BP drugs
n	100	38	30	17	9	6
Age (years)	60 ± 13	54 ± 12	63 ± 14	64 ± 12	65 ± 9	62 ± 6
Gender (female/male)	34/66	16/32	12/18	5/12	1/8	0/6
BMI (kg/m^2)	29.4 ± 4.7	30.4 ± 5.7	28.4 ± 3.9	28.0 ± 4.5	29.8 ± 2.7	30.7 ± 4.2
Duration of hypertension
<1 year	39 (39%)	29 (76%)	10 (33%)	0 (0%)	0 (0%)	0 (0%)
1–5 years	24 (24%)	6 (16%)	12 (40%)	5 (29%)	0 (0%)	1 (17%)
>5 years	37 (37%)	3 (8%)	8 (27%)	12 (71%)	9 (100%)	5 (83%)
Concomitant disease
Coronary heart disease	11 (11%)	0 (0%)	2 (7%)	3 (18%)	4 (44%)	2 (33%)
Cerebrovascular disease	5 (5%)	1 (4%)	3 (10%)	1 (6%)	0 (0%)	0 (0%)
Atrial fibrillation	5 (5%)	0 (0%)	2 (7%)	2 (12%)	0 (0%)	1 (17%)
Diabetes mellitus	10 (10%)	6 (16%)	2 (7%)	0 (0%)	0 (0%)	2 (33%)
COPD	6 (6%)	3 (8%)	3 (10%)	0 (0%)	0 (0%)	0 (0%)
Dyslipidemiaa	26 (26%)	5 (13%)	6 (20%)	4 (24%)	7 (78%)	4 (67%)
Previous treatment and BP related parameters
Beta-blockers	15 (15%)	0 (0%)	2	6 (35%)	3 (33%)	4 (67%)
Diuretics	32 (32%)	0 (0%)	13	7 (41%)	8 (89%)	4 (67%)
ARB	29 (29%)	0 (0%)	9	8 (48%)	7 (78%)	5 (83%)
ACE inhibitor	8 (8%)	0 (0%)	2	4 (24%)	2 (22%)	0 (0%)
CCB	18 (18%)	0 (0%)	3	4 (24%)	6 (67%)	5 (83%)
Other	13 (13%)	0 (0%)	1	5 (29%)	1 (11%)	6 (100%)
Sys BP (mmHg)	159 ± 13	160 ± 12	155 ± 13	163 ± 11	156 ± 11	162 ± 19
Dia BP (mmHg)	92 ± 10	97 ± 9	91 ± 9	86 ± 9	88 ± 11	90 ± 6
HR (bpm)	74 ± 10	76 ± 10	71 ± 12	70 ± 8	77 ± 9	79 ± 7

a On statin therapy.

Notes: Data are given as mean ± SD (continuous variables) and as counts (n) or % (categorical variables).

Abbreviations: HCT, hydrochlorothiazide; BP, blood pressure; BMI, body mass index; COPD, chronic obstructive pulmonary disease; ARB, angiotensin II receptor blocker; ACE, angiotensin converting enzyme; CCB, calcium channel blocker; sys, systolic; dia, diastolic; HR, heart rate; bpm, beats per minute.

Table 2 Impact on office BP 8 weeks after initiating or switching to telmisartan with or without HCT (any regimen) according to baseline number of BP-lowering drugs

	Total cohort	Treatment-naïve	1 BP drug	2 BP drugs	3 BP drugs	4 BP drugs
n	100	38	30	17	9	6
Baseline sys BP (mmHg)	159 ± 13	161 ± 13	155 ± 13	163 ± 11	156 ± 11	162 ± 19
Study end sys BP (mmHg)	139 ± 14	137 ± 15	138 ± 14	137 ± 11	146 ± 13	153 ± 11
Δ sys BP (mmHg)	− 20 ± 16***	− 24 ± 18***	− 17 ± 16***	− 26 ± 13***	− 10 ± 9**	− 9 ± 12
Baseline dia BP (mmHg)	92 ± 10	97 ± 9	91 ± 9	86 ± 9	88 ± 11	90 ± 6
Study end dia BP (mmHg)	82 ± 9	83 ± 9	81 ± 7	79 ± 7	77 ± 9	91 ± 11
Δ dia BP (mmHg)	−10 ± 10***	− 14 ± 10***	− 9 ± 10***	−7 ± 7***	− 4 ± 7	2 ± 4
Baseline HR (bpm)	74 ± 10	76 ± 10	71 ± 12	70 ± 8	77 ± 9	79 ± 7
Study end HR (bpm)	70 ± 12	71 ± 9	69 ± 11	70 ± 8	79 ± 10	63 ± 28
Δ HR (bpm)	−3 ± 12**	− 5 ± 11**	− 2 ± 14	0 ± 10	2 ± 8	− 16 ± 33

Notes: Data are given as mean ±SD.

* P < 0.05,

** P < 0.01,

*** P < 0.001.

Abbreviations: HCT, hydrochlorothiazide; sys, systolic; BP, blood pressure; dia, diastolic; Δ, delta (ie, BP change from baseline to study end); HR, heart rate; bpm, beats per minute.

Table 3 Effect of telmisartan therapy on office BP at 8 weeks according to baseline number of BP-lowering drugs

	Telmisartan 40 mg			Telmisartan 80 mg			Telmisartan 80 mg/HCT 12.5 mg
	n	Δ sys BP (mmHg)	Δ dia BP (mmHg)	n	Δ sys BP (mmHg)	Δ dia BP (mmHg)	n	Δ sys BP (mmHg)	Δ dia BP (mmHg)
Total cohort	28	−18 ± 17***	− 9 ± 11***	21	− 18 ± 20***	−10 ± 11***	51	− 22 ± 14***	− 9 ± 10***
Treatment-naïve	19	−18 ± 18***	− 11 ± 10***	6	− 28 ± 24*	− 19 ± 15*	13	− 30 ± 12***	−15 ± 8***
1 BP drug	5	−14 ± 16	− 5 ± 10	10	− 9 ± 13	− 7 ± 7*	15	− 23 ± 15***	−13 ± 11***
2 BP drugs	3	−30 ± 9*	− 10 ± 13	4	− 29 ± 23	− 8 ± 6	10	− 23 ± 10***	− 7 ± 5**
3 BP drugs	1	− 2	6	1	− 10	1	7	− 12 ± 10*	− 6 ± 6*
4 BP drugs	0	N/A	N/A	0	N/A	N/A	6	− 9 ± 12	2 ± 9

Notes: Data are given as mean ±SD and as counts (n).

* P < 0.05,

** P < 0.01,

*** P < 0.001.

Abbreviations: HCT, hydrochlorothiazide; Δ, delta; sys, systolic; dia, diastolic; BP, blood pressure; N/A, not applicable.

Table 4 Percentages of patients within target office BP(<140/90 mmHg) at baseline and study end (after 8 weeks of telmisartan with or without HCT) according to BP therapy at study entry

	Total cohort	Treatment naïve	1 BP drug	2 BP drugs	3 BP drugs	4 BP drugs
n	100	38	30	17	9	6
Baseline sys BP < 140 mmHg	3%	0%	7%	0%	0%	17%
8 weeks sys BP < 140 mmHg	54%***	61%***	57%***	59%**	33%§	0%
Baseline dia BP < 90 mmHg	38%	18%	40%	65%	56%	50%
8 weeks dia BP < 90 mmHg	75%***	76%***	80%**	88%	67%	33%
Baseline sys/dia BP <140/90 mmHg	2%	0%	3%	0%	0%	17%
8 weeks sys/dia BP <140/90 mmHg	45%***	50%***	47%**	53%***	33%§	0%

** P < 0.01,

*** P < 0.001;

§ P = 0.059.

Abbreviations: BP, blood pressure; HCT, hydrochlorothiazide.

Figure 1 24-hour ambulatory BP incl. mean ± SD at baseline and study end in A) total cohort (n = 69); and according to number of BP-lowering drugs at baseline: B) none (n= 31), C) 1 (n = 17), D) 2 (n = 9) and E) 3 or 4 (n = 12) drugs.

Notes: — Baseline hourly sys BP, ... 8-weeks hourly sys BP, --- Baseline hourly dia BP, -..- 8-weeks hourly dia BP, • Baseline 24-hour sys BP, ○ 8-weeks 24-hour sys BP, ▾ Baseline 24-hour dia BP, ▿ 8-weeks 24-hour dia BP, *P < 0.05, ***P < 0.001, ^§P = 0.085.
Abbreviations: sys, systolic; BP, blood pressure; dia, diastolic.

Table 5 Eight-week incidence of adverse events and prescribing physician’s subjective evaluation of efficacy and tolerability according to telmisartan treatment regimen

	Total cohort	40 mg telmisartan	80 mg telmisartan	80 mg telmisartan/2.5 mg HCT
n	100	28	21	51
Adverse events
Serious AE	0 (0%)	0 (0%)	0 (0%)	0 (0%)
Minor AE	9 (9%)	7 (25%)	0 (0%)	2 (4%)
Treatment efficacy as judged by the prescribing physician
Very good	44 (44%)	11 (39%)	9 (43%)	24 (47%)
Good	34 (34%)	12 (43%)	8 (38%)	14 (27%)
Moderate	13 (13%)	1 (3%)	3 (14%)	9 (18%)
Bad	5 (5%)	1 (3%)	1 (5%)	3 (6%)
Not determined	4 (4%)	3 (8%)	0 (0%)	1 (2%)
Treatment tolerability as judged by the prescribing physician
Very good	66 (66%)	18 (64%)	13 (62%)	35 (69%)
Good	27 (27%)	5 (18%)	8 (38%)	14 (27%)
Moderate	4 (4%)	3 (8%)	0 (0%)	1 (2%)
Bad	0 (0%)	0 (0%)	0 (0%)	0 (0%)
Not determined	3 (3%)	2 (7%)	0 (0%)	1 (2%)

Abbreviations: AE, adverse events; HCT, hydrochlorthiazid.