Effects of Telmisartan with Hydrochlorothiazide versus Valsartan with Hydrochlorothiazide in Patients with Moderate-to-Severe Hypertension

Ravi Marfatia,Helmut Schumacher,William B White

doi:10.1155/2012/976828

Abstract

Combination therapy is recommended for patients with blood pressure (BP) significantly above goal by recent consensus guidelines around the globe. The use of angiotensin II receptor blockers (ARBs) alone or in combination with a thiazide diuretic is a preferred treatment strategy due to both efficacy and safety considerations. However, there are few data known about the benefits of ARB-diuretic combination therapy in patients with moderate-to-severe hypertension. We performed a subanalysis from two large clinical trials that compared the antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg in a subpopulation of 725 patients with moderate-to-severe hypertension (systolic BP SBP ≥ 160 mm Hg). Treatment with telmisartan-HCTZ induced significantly greater reductions in BP (−31.1/−18.3 mm Hg) than valsartan-HCTZ (−28.4/−16.3 mm Hg; SBP P = 0.0265, diastolic BP P = 0.0041). More patients receiving the telmisartan combination achieved a BP goal < 140/90 mm Hg than those receiving valsartan-HCTZ. There were similar safety and tolerability data for the two active treatment groups. These findings support the use of longer-acting ARBs combined with higher doses of thiazide diuretic to improve BP control in patients with moderate-to-severe hypertension.

Highlights

The angiotensin II receptor blockers (ARBs) are effective antihypertensive agents with tolerability profiles similar to placebo [1,2,3,4]
We performed a subanalysis from two large clinical trials that compared the antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg in a subpopulation of 725 patients with moderate-to-severe hypertension
A pooled analysis of these two studies provided support for the use of ARBs with this higher 25 mg dose of thiazide diuretic; the analysis demonstrated that telmisartan 80 mg plus HCTZ mg (T80/H25) resulted in greater reductions in clinic blood pressure (BP) than V160/H25 [17]

Summary

Introduction

The angiotensin II receptor blockers (ARBs) are effective antihypertensive agents with tolerability profiles similar to placebo [1,2,3,4]. The use of ARBs and/or angiotensin converting enzyme (ACE) inhibitors, alone or in combination with a calcium channel blocker or with a thiazide diuretic, has become the cornerstone of hypertension management [2, 5, 6]. A series of landmark clinical trials have demonstrated that ARBs reduce cardiovascular (CV) morbidity and mortality in a variety of types of hypertensive patients [7,8,9,10,11,12,13]. A pooled analysis of these two studies provided support for the use of ARBs with this higher 25 mg dose of thiazide diuretic; the analysis demonstrated that T80/H25 resulted in greater reductions in clinic BP than V160/H25 [17]

Methods

Results

Discussion

Conclusion