The comparative effects of telmisartan and ramipril on P-wave dispersion in hypertensive patients: A randomized clinical study

Çelik, Turgay; İyisoy, Atila; Kurşaklıoğlu, Hürkan; Yılmaz, Mahmut İlker; Köse, Sedat; Kılıç, Selim; Amasyalı, Basri; Demırkol, Sait; Işık, Ersoy

doi:10.1002/clc.4960280609

Cited by 44 publications

(28 citation statements)

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“…Moreover, ARBs can inhibit Ang II activity in the left atrium, which may contribute to nonhomogeneous atrial conduction. ARBs may have a greater effect on atrial electrophysiological properties than ACEIs [29]. So ARBs has important beneficial effects on atrial stretch, interstitial fibrosis, inflammation, and eventually structural remodeling, all of which serve as a substrate for the persistence and recurrence of AF.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, telmisartan was shown to significantly improve the sympathovagal balance, increasing parasympathetic activity and significant reducing QT dispersion in hypertensive subjects [39]. Celik [29] suggested telmisartan has a much greater lowering effect on P-wave dispersion and P maximum values than ramipril in the prevention of AF in hypertensive patients. Sengul [40] also demonstrated the P-wave measurements and the atrial electromechanical delay (EMD) parameters in patients with newly diagnosed essential hypertension were significantly decreased after 6-month telmisartan therapy.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

Pan

Zhou

Zhao

2014

Cardiovascular Therapeutics

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SUMMARYBackground: The systematic review and meta-analysis are to evaluate the effect of t Telmisartan on atrial fibrillation (AF) recurrences in hypertensive patients with paroxysmal AF. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Random controlled trials (RCTs) were conducted in which telmisartan was compared to other antihypertensive drugs for AF recurrences prevention in hypertensive patients with paroxysmal AF. A systematic review and meta-analysis based on aggregate data extracted from the included studies were carried out to assess the telmisartan in preventing AF relapse. The efficacy outcome was the incidence of AF recurrences. Hazard ratios (HRs) were calculated from published summary statistics and combined to give pooled estimates of efficacy. Results: This meta-analysis comprised four studied including 1050 hypertensive patients (537 men and 513 women; mean age 63; mean blood pressure (BP) 156/94 mmHg). With the similar BP control, the AF recurrences rate was significantly lower in the telmisartan-treated patients than in the other antihypertensive drugs-treated patients (HR 0.54, CI 0.34-0.86, P < 0.05). Conclusion: The results of this review and meta-analysis indicate that telmisartan seems to be more effective than other antihypertensive drugs in preventing AF recurrences among hypertensive patients with paroxysmal AF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

Pan

Zhou

Zhao

2014

Cardiovascular Therapeutics

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“…14,22,25,27,28,41,69,78,79,84,88,89,92 Apart from one study in which there was a greater reduction of left ventricular hypertrophy with an ARB, 89 there were no differences between ACE inhibitor and ARB groups. Only one study evaluated a DRI; it found similar effects between aliskiren and an ARB.…”

Section: Left Ventricular Mass or Functionmentioning

confidence: 98%

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

et al. 2011

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OBJECTIVES:A 2007 systematic review compared angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in patients with hypertension. Direct renin inhibitors (DRIs) have since been introduced, and significant new research has been published. We sought to update and expand the 2007 review. DATA SOURCES: We searched MEDLINE and EMBASE (through December 2010) and selected other sources for relevant English-language trials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included studies that directly compared ACE inhibitors, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of follow-up; and reported at least one outcome of interest. Ninety-seven (97) studies (36 new since 2007) directly comparing ACE inhibitors versus ARBs and three studies directly comparing DRIs to ACE inhibitor inhibitors or ARBs were included. STUDY APPRAISAL AND SYNTHESIS METHODS: A standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. RESULTS: In spite of substantial new evidence, none of the conclusions from the 2007 review changed. The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents, as well as for superiority of ARBs for short-term adverse events (primarily cough). However, the new evidence was insufficient on long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, and differences in key patient subgroups. LIMITATIONS: Included studies were limited by followup duration, protocol heterogeneity, and infrequent reporting on patient subgroups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects. Few, if any, of the questions that were not answered in the 2007 report have been addressed by the 36 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly. CLINICAL CASEA 54-year-old woman with a history of hypertension is seen by her doctor for persistently elevated blood pressure in spite of adherence to hydrochlorothiazide 25 mg daily. She is overweight and has a strong family history of coronary artery disease. To control her blood pressure, she and her doctor discuss adding an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin II receptor blocker (ARB), or a direct renin inhibitor (DRI) to her regimen. She is primarily interested in avoiding the cardiovascular complications of hypertension, but does not want to take medication more than once a day, and she is concerned about side effects and the cost of her medication. What information is available to help guide her decision?Electronic supplementary material The online version of this article

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“…to improve two parameters shown to be independent predictors of atrial fibrillation. 70 Further, and more sophisticated information on the effects of the drug treatment on cardiac morphology, will come from the results of ongoing studies performed in the context of the already mentioned ONTARGET Trial, in which the use of magnetic resonance for assessing LV mass index will provide well defined data on the impact of the drug on hypertensionrelated cardiac organ damage. 71,72 Clinical studies carried out in human hypertension, however, have also allowed us to define the effects of the chronic Ang II blockade via telmisartan on vascular structure and function.…”

Section: Reviewmentioning

confidence: 99%

Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension

Quartı-Trevano

Mancia

2008

J Renin Angiotensin Aldosterone Syst

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The development of angiotensin II receptor blockers (ARB) as a new class of drugs for the management of hypertension has elicited the attention of many clinicians worldwide with the aim of improving blood pressure (BP) control as well as cardiovascular protection.AmongARB telmisartan has been shown to be characterised by an antihypertensive efficacy fully covering the 24-hour period, thereby allowing to antagonise the adverse effects of early morning BP rise on cardiovascular risk. Other specific effects of the drug are represented by its favourable metabolic profile (particularly on insulin sensitivity) and neutral effects on sympathetic cardiovascular function.These properties are coupled with cardioprotective effects, documented by the evidence that the drug: 1) is effective in favouring the regression of cardiac and vascular organ damage, 2) reduces arterial stiffness and improves vascular distensibility and 3) reverses the endothelial dysfunction typical of the hypertensive state particularly when complicated by renal failure, diabetes, obesity or metabolic syndrome. Several of these properties can account for the results of the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), documenting the beneficial effects on the drug on cardiovascular morbidity and mortality.

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The comparative effects of telmisartan and ramipril on P-wave dispersion in hypertensive patients: A randomized clinical study

Abstract: Telmisartan has a much greater lowering effect on PWD and Pmaximum values than ramipril. This finding may be important in the prevention of AF in hypertensive patients.

Cited by 44 publications

References 23 publications

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension

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