Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure impact on the early morning period

White, William Β.; Lacourcière, Yves; Davidai, Giora

doi:10.1016/j.amjhyper.2004.02.016

Cited by 118 publications

(72 citation statements)

References 14 publications

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“…The results of our analysis can be explained in part by the pharmacokinetic profile of telmisartan, which is characterized by a longer half-life than valsartan, 9,12 and by earlier pharmacodynamic studies using ambulatory BP monitoring that showed greater BP reductions on telmisartan compared with valsartan without the diuretic component. [16][17][18] This study also confirms and extends what had been shown regarding the combination therapies for the angiotensin II receptor blockers that use a higher dose of HCTZ (25 mg), 13,14 an option that has been shown to be increasingly useful in management of clinical hypertension. 3,12 Effects of angiotensin receptor blockers in combination with HCTZ A number of fixed-dose combination therapies of angiotensin receptor blocking agents and diuretics are currently available for the treatment of hypertension.…”

Section: Principal Findingssupporting

confidence: 81%

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

2009

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The antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg, were assessed in a pooled analysis from two large trials with identical study designs in patients with stage 1-2 hypertension. The trials were double-blind with a 4:4:1 randomization scheme to compare once-daily telmisartan 80 mg and HCTZ 25 mg versus once-daily valsartan 160 mg and HCTZ 25 mg versus once-daily placebo on reductions in clinic blood pressure (BP). The primary end point was changes from baseline in BP at the end of 8 weeks. In total, 2121 patients were randomized (telmisartan-HCTZ, 942, valsartan-HCTZ, 952, and placebo, 227) and had baseline seated BPs of 154/102 and 155/102 mm Hg in the two studies, respectively. Changes from baseline in BP after administration of telmisartan-HCTZ (À24.5/ À18.0 mm Hg) were significantly greater than for both placebo (À4.1/À6.5 mm Hg) and valsartan-HCTZ (À22.3/ À16.8 mm Hg) (versus placebo, Po0.0001 for systolic and diastolic BP; versus valsartan-HCTZ, P ¼ 0.0004 for systolic BP and P ¼ 0.0019 for diastolic BP). Adverse event rates were higher in the placebo group than in the active treatment groups (placebo, 41%, telmisartan-HCTZ, 30%, and valsartan-HCTZ, 30%, Po0.05). These data confirm that telmisartan-HCTZ at doses of 80/25 mg lowered systolic and diastolic BP to a greater extent than valsartan-HCTZ at doses of 160/25 mg in stage 1-2 hypertension. The magnitude of the BP-lowering effect provides support for the use of angiotensin receptor blockers with higher doses of a thiazide diuretic (25 mg) to improve hypertension control.

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Section: Principal Findingssupporting

confidence: 81%

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

2009

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“…The small loss in ambulatory BP-lowering effect of 1.0/0.7 mm Hg with aliskiren in the 24-48-h period relative to the 0-24-h period compares favourably not only with that observed with irbesartan (3.6/2.2 mm Hg) or ramipril (4.0/2.6 mm Hg) in this study, but also with that observed with other antihypertensive drugs in previous studies. [10][11][12][13] Although comparisons across different studies must be interpreted with caution, the only other study that has reported a p1 mm Hg loss of 24-h ambulatory SBP/DBP-lowering effect in the 24-48-h postdose period relative to the 0-24-h period involved amlodipine, 10 an agent well known for its long duration of action. This study also used a simulated non-adherence phase, involving morning and evening self-measurement of BP by patients at home, to Sustained BP reduction beyond 24 h with aliskiren P Palatini et al evaluate BP-lowering effects up to 72 h after dose (that is, following two successive simulated missed doses of treatment).…”

Section: Discussionmentioning

confidence: 99%

Maintenance of blood-pressure-lowering effect following a missed dose of aliskiren, irbesartan or ramipril: results of a randomized, double-blind study

et al. 2009

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Most patients inadvertently miss an occasional dose of antihypertensive therapy, and hence drugs that provide sustained blood-pressure (BP) reduction beyond the 24-h dosing interval are desirable. The primary objective of this study was to compare the 24-h mean ambulatory BP reductions from baseline after a simulated missed dose of the direct renin inhibitor aliskiren, irbesartan or ramipril. In this double-blind study, 654 hypertensive patients (24-h mean ambulatory diastolic BP (MADBP) X85 mm Hg) were randomized 1:1:1 to once-daily aliskiren 150 mg, irbesartan 150 mg or ramipril 5 mg. Doses were doubled after 2 weeks. At day 42, patients were again randomized equally within each group to receive 1 day of placebo ('missed dose') on either day 42 or day 49. Patients with a successful 24-h ambulatory BP measurement at baseline and on day 42/49 were included in the analyses. The 24-h mean ambulatory systolic BP (MASBP)/MADBP reductions from baseline after a missed dose of aliskiren 300 mg (9.3/7.0 mm Hg) were similar to irbesartan 300 mg (9.5/7.3 mm Hg) and significantly larger than ramipril 10 mg (7.1/5.0 mm Hg, Pp0.008). Loss of BP-lowering effect with aliskiren in the 24 h after a missed dose (1.0/0.7 mm Hg for 24-48-h vs 0-24-h MASBP/MADBP) was significantly lower than with irbesartan (3.6/2.2 mm Hg, Po0.01) or ramipril (4.0/2.6, Po0.0001). This equates to maintenance of 91/91% of the MASBP/MADBP-lowering effect with aliskiren, greater than irbesartan (73/77%) or ramipril (64/65%). The incidence of adverse events was similar across treatments (32.9-36.0%), although ramipril treatment was associated with an increased incidence of cough (ramipril, 6.1%; aliskiren, 0.5%; irbesartan, 1.8%). Aliskiren 300 mg provided a sustained BP-lowering effect beyond the 24-h dosing interval, with a significantly smaller loss of BP-lowering effect in the 24-48 h period after dose than irbesartan 300 mg or ramipril 10 mg.

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“…This study was undertaken to compare the antihypertensive effects and renal and vascular protective effects of the ARB telmisartan and the calcium antagonist amlodipine, which both exhibit a long-acting profile (3,6). In this study, the test drugs were administered as monotherapy to 2 groups of patients with untreated essential hypertension, unlike in many other large-scale studies that have been conducted in treated patients or patients on combination therapy.…”

Section: Discussionmentioning

confidence: 99%

Renal and Vascular Protective Effects of Telmisartan in Patients with Essential Hypertension

et al. 2006

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Effects of the angiotensin II receptor blockers telmisartan versus valsartan on the circadian variation of blood pressure impact on the early morning period

Cited by 118 publications

References 14 publications

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

Maintenance of blood-pressure-lowering effect following a missed dose of aliskiren, irbesartan or ramipril: results of a randomized, double-blind study

Renal and Vascular Protective Effects of Telmisartan in Patients with Essential Hypertension

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