Impact of angiotensin receptor blockade in combination with hydrochlorothiazide
25 mg in 2121 patients with stage 1-2 hypertension.
Author(s): White WB(1), Davidai G, Schumacher H.
Affiliation(s): Author information:
(1)Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun
Cardiology Center, University of Connecticut School of Medicine, Farmington, CT
06030, USA. Wwhite@NSO1.uchc.edu
Publication date & source: 2009, J Hum Hypertens. , 23(12):817-25
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 (-24.5/-18.0 mm Hg) were significantly greater
than for both placebo (-4.1/-6.5 mm Hg) and valsartan-HCTZ (-22.3/-16.8 mm Hg)
(versus placebo, P<0.0001 for systolic and diastolic BP; versus valsartan-HCTZ,
P=0.0004 for systolic BP and P=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%, P<0.05). 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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