"Using the maximum recommended doses, telmisartan 80 mg significantly reduced the systolic early morning blood pressure surge compared with ramipril 10 mg in the subgroup of patients with the highest surge," said Philippe Gosse, MD, a hypertension specialist at Centre Hospitalier Régional de Bordeaux, France.

"A large volume of circumstantial evidence has accrued showing that early morning blood pressure surge is associated with an elevated incidence of acute cardiovascular events," said Dr. Gosse. Hence, the researchers investigated data from clinical trials in an ad hoc fashion to determine if either drug appeared more protective of patients in those critical early morning hours.

The researchers analyzed data from two identical, prospective, open-label, blinded endpoint, randomized studies that recruited patients with a seated blood pressure of < 180/95-109 mmHg and 24-hour mean ambulatory diastolic blood pressure of greater than or equal to 85 mmHg and no comorbidities. The 802 patients on telmisartan received 40 mg for 2 weeks then 80 mg for 12 weeks. The 811 patients on ramipril received 2.5 mg for 2 weeks, were uptitrated to 5 mg for 6 weeks, and then received 10 mg for the remaining 6 weeks.

Data from 684 patients on telmisartan and 619 on ramipril who completed 24-hour ambulatory blood pressure monitoring were examined. Early morning blood pressure surge was defined as the difference between nighttime low and early morning mean blood pressure, and patients were grouped into quartiles according to baseline early morning blood pressure surge.

"Telmisartan showed small but statistically significant reductions in systolic blood pressure surge in the quartiles with lower blood pressure surge," explained Dr. Gosse. "Reductions were greater and statistically significant in the highest quartile (34 mmHg), in whom telmisartan reduced systolic surge by 12.4 mmHg and ramipril by 7.1 mmHg." That difference reached statistical significance at the P = .0001 level, he said.

"The superior control of the systolic early morning blood pressure surge in patients at high risk with telmisartan may confer a beneficial effect on cardiovascular outcomes which appear to be associated with the early morning blood pressure surge," concluded Dr. Gosse.


[Presentation title: Reduction of Early Morning Blood Pressure Surge With Telmisartan Compared With Ramipril in Mild-to-Moderate Hypertensive Patients.]

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