Source: Europace  |  Posted 8 years ago

Adding telmisartan to existing antihypertensive therapy for patients with essential hypertension significantly reduces blood pressure compared to placebo, reports a multinational study.

Whereas use of combined drugs to manage hypertension is now common in clinical practice, optimal combination of drugs is still unclear. Because of the need to fully lower blood pressure over 24 hours, use of an antihypertensive agent with a long duration of action, such as telmisartan, is considered important to optimised treatment.

In this prospective, double-blind, randomised, multicentre trial, Blas Gil-Extremera, MD, San Cecilio Hospital, Granada, Spain, and colleagues evaluated the safety and benefit of adding telmisartan monotherapy to existing antihypertensive therapy in 375 patients who had uncontrolled hypertension on their existing therapies. Of these, 360 patients were randomised - 178 to receive telmisartan (once daily for 8 weeks) and 182 to receive placebo. Patients receiving telmisartan began at a dose of 40 mg and after 4 weeks increased to 80 mg if achieving diastolic blood pressure (DBP) of > 90 mm Hg.

Outcomes measured included the change in mean DBP from baseline to over the last 6 hours of dosing determined by ambulatory blood pressure monitoring (primary outcome), and change from baseline of mean systolic blood pressure (SBP) measured over the last 6 hours of dosing, mean 24-hour DBP and SBP, mean trough seated DBP and SBP, and responder rates (secondary outcomes).

Compared to placebo, patients treated with telmisartan had significantly greater reductions in DBP over the last 6 hours of treatment (-3.7 vs. -1.9 mm Hg, respectively; []P[] < .001) and 24-hour DBP (-5.0 vs. -3.5 mm Hg, respectively; []P[] < .001) after 8 weeks of treatment. Similar significant reductions associated with telmisartan were noted in SBP compared to placebo, with a mean treatment difference of -4.8 mmHg for SBP over the last 6 hours of treatment and a mean treatment difference of -6.8 mmHg for 24-hour SBP. Trough seated DBP and SBP were also significantly reduced with telmisartan.

Overall, telmisartan was well tolerated. Of the full cohort of 375 patients, 26% in the telmisartan group reported adverse events, which were primarily mild events with only 6% of the events attributed to telmisartan. Serious adverse events were reported in only 1% of the telmisartan-treated patients.

The authors conclude that the addition of telmisartan to antihypertensive therapy is a good combination that "maximizes the effects on blood pressure reduction while maintaining drug tolerability and with minimal side effects."