Telmisartan plus hydrochlorothiazide (80/25 mg) has a greater antihypertensive effect than valsartan plus hydrochlorothiazide (160/25 mg) in patients with stage 1 and 2 hypertension

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To achieve more rigorous blood pressure (BP) control as recommended by JNC-7, highly effective combination therapies are needed. Recently, angiotensin receptor blockers with higher doses of hydrochlorothiazide (HCT), ie, 25 mg daily, have been acknowledged as an effective form of antihypertensive therapy. To evaluate the newest telmisartan formulation in combination with HCT 25 mg, we carried out a double-blind, placebo-controlled trial with valsartan HCT as comparator in 1109 patients with stage 1 or 2 hypertension. The primary end point was change from baseline in seated systolic and diastolic clinic BP. The intent-to-treat efficacy analysis included 1066 patients with a mean age of 53 years; 73% were white, 25% black, and 2% Asian; 58% were men and 42% women, with 5% more women in the telmisartan than in the valsartan group; body mass index was 32 kg/m2. There were no differences in demographics or in baseline BP among the 3 treatment groups. Telmisartan HCT induced greater reductions in systolic and diastolic BP (−2.8/−1.5 mm Hg) than did valsartan HCT. This effect was greater in patients <65 years of age (P<.002) and in women compared with men (P=.0007). Telmisartan HCT lowered BP more in black subjects than valsartan HCT (−2.4/−1.5 mm Hg; P≤.03 for both). In conclusion, telmisartan HCT produced a statistically superior reduction in both systolic and diastolic BP compared with placebo and valsartan HCT. (See Table) Δ DBP, change in diastolic BP; Δ SBP, change in systolic BP; HCT, hydrochlorothiazide; CI, confidence interval. Δ DBP, change in diastolic BP; Δ SBP, change in systolic BP; HCT, hydrochlorothiazide; CI, confidence interval.