PMID: 15361777

Issn Print: 0263-6352

Publication Date: 2004/10/01


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Effects of telmisartan 80 mg and valsartan 160 mg on ambulatory blood pressure in patients with essential hypertension

William B White; Yves Lacourciere

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Author Information: Section of Hypertension and Clinical Pharmacology, University of Connecticut Health Centre, Farmington, Connecticut, USA and

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Recently, Calvo et al. [1] reported the results of a clinical trial that evaluated the blood pressure-lowering effects of telmisartan (80 mg) versus valsartan (160 mg) following 48-h ambulatory blood pressure monitoring [1]. The results of their study are somewhat remarkable because the authors show that, compared to baseline, valsartan (160 mg daily) lowered the 24-h blood pressure by –18.6/–12.1 mmHg while telmisartan (80 mg) lowered the 24-h blood pressure by –10.8/–8.4 mmHg. Although the ambulatory blood pressure effects of telmisartan 80 mg observed in this study are similar to the results of other trials [2,3], the reductions in 24-h systolic and diastolic blood pressure for valsartan are not in agreement with several clinical hypertension trials evaluating the effects of valsartan on ambulatory blood pressure (Table 1) [2–7]. In most other studies [2–4,7,8], the maximal reduction from baseline of the 24-h systolic blood pressure by valsartan at a dose of 160 mg daily was in the range of 9–10 mmHg. Furthermore, in comparative studies of valsartan with telmisartan [2,3], telmisartan lowered the ambulatory blood pressure to a greater extent than valsartan, which is in direct contrast to the findings of Calvo et al. [1]. It has been suggested that the large reductions in ambulatory blood pressure observed at the end of the dosing period in patients administered telmisartan once daily are due in part to its long plasma half-life of 24 h [2,3,9].
The discrepancies in the findings of this study reported by Calvo et al. [1] versus those of several other trials are likely to be multi-factorial, and associated with certain important differences among the various studies. For example, in the study by Calvo et al. [1], the sample size is relatively small (36 patients on valsartan) and the design was open-label. In a study by our group, which showed that telmisartan 80 mg lowered ambulatory blood pressure at trough to a greater extent than valsartan 160 mg [2], the sample was larger (246 patients on valsartan and 244 on telmisartan) and the design was multicentre, double-blind and randomized. Another concern related to the findings of Calvo et al. [1] was that the baseline clinical and ambulatory blood pressures were notably higher in patients treated with valsartan (average of six clinical blood pressures: 156.5/91.9 mmHg) than those treated with telmisartan (average of six clinical blood pressures: 151.5/89.3 mmHg). It is has been shown that antihypertensive drugs may lower ambulatory blood pressure to a greater extent in patients with higher baseline blood pressures [9].
In summary, we have demonstrated that the findings of Calvo et al. [1], related to the reductions in ambulatory blood pressure on valsartan versus telmisartan, are in conflict with our two much larger studies [2,3], as well as a number of smaller studies which do not show that valsartan induces such a substantial reduction in 24-h systolic blood pressure.

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