Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

Apr 10, 2009Journal of human hypertension

Effects of Blocking Angiotensin Receptors with Hydrochlorothiazide 25 mg in Over 2,000 Patients with Mild to Moderate High Blood Pressure

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Abstract

In a pooled analysis of 2121 patients, telmisartan 80 mg combined with hydrochlorothiazide lowered blood pressure by 24.5/18.0 mm Hg after 8 weeks.

Telmisartan-HCTZ showed significantly greater reductions in blood pressure compared to placebo (-4.1/-6.5 mm Hg) and valsartan-HCTZ (-22.3/-16.8 mm Hg).
The reduction in systolic blood pressure with telmisartan-HCTZ was statistically significant compared to both placebo (P<0.0001) and valsartan-HCTZ (P=0.0004).
Diastolic blood pressure reductions with telmisartan-HCTZ were also significantly greater than valsartan-HCTZ (P=0.0019).
Adverse event rates were lower in both active treatment groups (30%) compared to the placebo group (41%, P<0.05).
These findings suggest that telmisartan combined with hydrochlorothiazide may provide more effective blood pressure control than valsartan with the same diuretic.

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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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Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1–2 hypertension

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