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Valsartan Appears More Effective Than Telmisartan in Patients With Essential Hypertension

Valsartan 160 mg/day is more effective in lowering blood pressure over a 24-hour period, than is telmisartan 80 mg/day, according to a recent Spanish study.

Furthermore, valsartan is more effective than is telmisartan in reducing arterial pulse pressure (PP), a potential risk factor for cardiovascular events, write researchers led by Dr Carlos Calvo, Hypertension and Vascular Risk Unit, Hospital Clinico Universitario, Santiago de Compostela.

Seventy previously untreated white patients (38 women, mean age 47.6 years) with mild-to-moderate essential hypertension were enrolled in this prospective, randomised, open-label, parallel-group trial. The investigators sought to compare the antihypertensive efficacy of valsartan and telmisartan used at their maximum recommended dose in Spain.

The patients received a single daily tablet of either valsartan 160 mg or telmisartan 80 mg, in the morning upon awakening from night-time sleep.

Valsartan is a specific and selective angiotensin II receptor blocker (ARB). A single morning dose of orally active valsartan provides effective blood pressure (BP) control throughout the day without interfering with the circadian pattern of BP variation.

Telmisartan is a well-tolerated non-peptide ARB, also administered once a day, with an elimination half-life close to 24 hours.

Ambulatory blood pressure monitoring (ABPM) was recorded for 48 hours immediately before and after 3 months of treatment. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of each patient were automatically assessed every 20 minutes during the day and every 30 minutes during the night. During the 48-hour ABPM, each patient wore an actigraph on the dominant wrist to monitor physical activity every minute.

Analysis of ABPM in patients treated with valsartan resulted in a highly statistically significant reduction in BP from baseline after 3 months of treatment: 18.6 mm Hg and 12.1 mm Hg reduction in the estimated 24-hour mean of SBP and DBP, respectively.

A highly significant reduction of 6.5 mm Hg in the 24-hour mean of pulse pressure (PP) was obtained after valsartan administration. The 24-hour mean of PP was not significantly reduced from baseline with telmisartan (difference of 2.2 mm Hg, P = 0.154).

At the end of the study, the 24-hour mean BP was statistically lower in the valsartan-treated group compared to telmisartan-treated group (P < .001 for SBP; P = .014 for DBP). Results revealed a statistically significant difference between treatment-groups in the effects of valsartan or telmisartan on the diurnal, nocturnal, and 24-hour means of SBP and DBP.

The average reduction in DBP in the last 6 hours of dosing interval was significantly greater for valsartan than for telmisartan (10.6 mmHg compared to 7.6 mmHg, respectively; P = .006).

"Accordingly, at the dose here investigated, valsartan provides a significantly larger effect on SBP than on DBP, thus providing a statistically significant reduction in PP for most of the 24 hours," the authors add.

J Hypertens 2004 Apr;22(4):837-46

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