Sustained antihypertensive activity of telmisartan compared with valsartan

Lacourcière, Yves; Krzesinski, Jean-Marie; White, William Β.; Davidai, Giora; Schumacher, Helmut

doi:10.1097/00126097-200408000-00005

Cited by 89 publications

(57 citation statements)

References 15 publications

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“…Not surprisingly, both fixed-dose combination agents lowered BP to a much greater extent than placebo. The findings between the active treatment groups were predictable, in part, considering the pharmacokinetic profile of telmisartan, which is characterized by a longer half-life than valsartan [9,12] and previous pharmacodynamic studies using ambulatory BP monitoring that showed greater BP reductions on telmisartan compared with valsartan without the diuretic component [15][16][17]. Thus, the current study confirms what has already been demonstrated comprehensively regarding the combination therapies for the angiotensin II receptor blockers that utilize a higher dose of hydrochlorothiazide (25 mg) [13], an option that has been shown to be increasingly useful in clinical hypertension management [3,12].…”

Section: Principal Findingsmentioning

confidence: 63%

See 1 more Smart Citation

Effects of the angiotensin II receptor blockers telmisartan versus valsartan in combination with hydrochlorothiazide: a large, confirmatory trial

White

Murwin

Chrysant

et al. 2008

Blood Pressure Monitoring

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In 2004-2005, the antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg combined with hydrochlorothiazide 25 mg were assessed in a large placebo-controlled trial in patients with stages 1 and 2 hypertension and demonstrated that both agents were highly effective in lowering blood pressure (BP) compared with placebo and that telmisartan lowered BP significantly greater than valsartan. To confirm this finding according to Food and Drug Administration guidelines, we performed a second large trial using the same design in an entirely separate patient population. The trial was double-blind with a 4 : 4 : 1 randomization scheme to compare once daily telmisartan 80 mg plus hydrochlorothiazide 25 mg versus once daily valsartan 160 mg plus hydrochlorothiazide 25 mg versus once daily placebo on reductions in seated clinic BP in patients with stages 1 and 2 hypertension. The primary endpoints were the changes from baseline in seated diastolic and systolic BP at the end of the 8-week treatment period. Safety endpoints included adverse events, changes in laboratory parameters and pulse rate. In total, 1185 patients were randomized (of which 1181 were treated and included in the primary analysis: 528 in the telmisartan-hydrochlorothiazide group, 523 in the valsartan-hydrochlorothiazide group, and 130 in the placebo group), changes from baseline in BP following telmisartan-hydrochlorothiazide (-24.6/-18.2 mmHg) were significantly greater than both placebo (-4.1/-6.1 mmHg) and valsartan-hydrochlorothiazide (-22.5/-17.0 mmHg) (versus placebo, P<0.0001 for systolic and diastolic BP; versus valsartan-hydrochlorothiazide, P=0.017 for systolic BP and P=0.025 for diastolic BP). The total number of patients with at least one adverse event reported was similar among the three treatment groups (placebo, 42%, telmisartan-hydrochlorothiazide, 36%, and valsartan-hydrochlorothiazide, 37%). Thus, this large, second trial confirms that telmisartan-hydrochlorothiazide at doses of 80/25 mg lowered both systolic and diastolic BP to a greater extent than valsartan-hydrochlorothiazide at doses of 160/25 mg in stages 1-2 hypertension. Although these are not the highest doses of these agents at present, at the time that the studies were conducted, they were the maximally approved dosages. Both studies support the strategy of using angiotensin receptor blockers with a higher dose of a thazide diuretic (25 mg) for enhancing the control of hypertension.

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Section: Principal Findingsmentioning

confidence: 63%

“…The primary findings demonstrated that telmisartan-HCT 80/25 lowered both the systolic and diastolic BP to a greater extent than valsartan-HCT MedDRA preferred term [17]. BP, blood pressure; HCT, hydrochlorothiazide.…”

Section: Principal Findingsmentioning

confidence: 99%

Effects of the angiotensin II receptor blockers telmisartan versus valsartan in combination with hydrochlorothiazide: a large, confirmatory trial

White

Murwin

Chrysant

et al. 2008

Blood Pressure Monitoring

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“…Amlodipine and telmisartan have long half-lives and, therefore, long duration of action. Indeed, telmisartan provides longlasting and consistent BP control over a 24-h period compared with other renin-angiotensin system inhibitors [9,[27][28][29], and this is the case also for amlodipine when compared with other calcium channel blockers [30,31]. Visitto-visit variability in SBP and maximum SBP are strong predictors of stroke, and in patients with treated hypertension, increased 24-h residual variability in SBP is associated with a high risk of vascular events [32].…”

Section: Discussionmentioning

confidence: 99%

Impact of antihypertensive combination and monotreatments on blood pressure variability

Parati

Ley

Schumacher

2014

Journal of Hypertension

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As compared with various monotherapies, the telmisartan/amlodipine combination was associated with a smoother BP reduction over 24 h and with a more favourable balance between mean 24-h BP reduction and the degree of BP variability on treatment, reflecting both its effectiveness in lowering BP levels and its longer duration of action. The agreement between smoothness index and TOVI demonstrates that they are similarly effective in the differentiation of antihypertensive treatments, although providing conceptually different information, the clinical relevance of which needs to be tested by ad-hoc outcome studies.

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“…In addition, ABPM data from the individual clinical studies available and meta-analysis of these data provide a clear demonstration of the 24-hour BP control provided by telmisartan and offer demonstration that the degree of BP reduction that is still evident at the end of the dosing interval is significantly greater than the corresponding BP reduction offered by other ARBs, such as losartan and valsartan [48][49][50][51]. In a study comparing telmisartan with valsartan, this was the case also in the event of a missed dose [52]. SIs computed from SBP and DBP ABPM measurements of fixed-dose studies of telmisartan demonstrate that telmisartan 80 mg has the highest SI for both SBP and DBP compared with losartan, valsartan, and amlodipine (Table 1) [53], thus further supporting its ability to provide a smooth and sustained antihypertensive activity throughout the interval between once-daily doses.…”

Section: Abpm Evaluation Of Antihypertensive Agents In Clinical Trialsmentioning

confidence: 99%

Guiding antihypertensive treatment decisions using ambulatory blood pressure monitoring

Mancia

Parati²

2006

Current Science Inc

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Compared with isolated clinic measurements, ambulatory blood pressure monitoring (ABPM) provides an insight into blood pressure (BP) changes in everyday life and an estimate of the overall BP load exerted on the cardiovascular system over 24 hours. Cross-sectional evidence suggests a direct and significant relationship between ambulatory BP and organ damage. There is also longitudinal evidence for a superior predictive value of 24-hour BP in relation to the risk for cardiovascular morbidity and mortality as opposed to clinic BP. The usefulness of ABPM in pharmacologic studies aimed at evaluating the 24-hour antihypertensive efficacy of different drugs and drug combinations is now acknowledged. Among the mathematical indices available to explore 24-hour BP coverage by treatment, the ABPM-derived smoothness index provides a superior measure of the homogeneity of BP control compared with trough:peak ratios. The main applications of clinical practice should be in identifying patients with isolated office hypertension and those who are nonresponders to treatment, in assessing coverage of the 24-hour BP profile in high-risk patients and in diagnosing suspected treatment-related hypotension.

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Sustained antihypertensive activity of telmisartan compared with valsartan

Abstract: Due to its longer half-life, telmisartan offers more sustained BP control, especially at the end of the dosing period and provides sustained efficacy in poorly compliant patients in the event of a missed dose with a statistical superiority compared with valsartan.

Cited by 89 publications

References 15 publications

Effects of the angiotensin II receptor blockers telmisartan versus valsartan in combination with hydrochlorothiazide: a large, confirmatory trial

Effects of the angiotensin II receptor blockers telmisartan versus valsartan in combination with hydrochlorothiazide: a large, confirmatory trial

Impact of antihypertensive combination and monotreatments on blood pressure variability

Guiding antihypertensive treatment decisions using ambulatory blood pressure monitoring

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