Key result
Telmisartan plus HCTZ was superior to amlodipine plus HCTZ in reducing 24-hour systolic blood pressure (-19.3 vs -17.2 mm Hg; p=0.001) and had fewer adverse events (41.2% vs 53.7%; p<0.0001).
Why the study?
Does telmisartan plus HCTZ reduce systolic blood pressure compared to amlodipine plus HCTZ in older patients with systolic hypertension?
RCT (n=872)
open-label, blinded-end point
randomized
Does telmisartan plus HCTZ reduce systolic blood pressure compared to amlodipine plus HCTZ in older patients with systolic hypertension?
Absolute Event Rate: -18.3% vs -17.4%
p-value: p=0.2520
In older patients with systolic hypertension, telmisartan plus HCTZ provided similar end-of-dosing interval blood pressure reduction but superior 24-hour control and fewer adverse events compared to amlodipine plus HCTZ.
Telmisartan plus HCTZ may improve ambulatory BP control versus amlodipine plus HCTZ in older systolic hypertension; leaves open effects on outcomes and broader applicability.
Systolic hypertension often requires combination therapy. Few data exist comparing angiotensin receptor blocker plus diuretic therapy with other combinations in older patients. In a prospective, randomized, open-label, blinded-end point trial, patients (> or =60 years of age) with predominantly systolic hypertension received telmisartan 40-80 mg or amlodipine 5-10 mg for 8 weeks, before the addition of hydrochlorothiazide (HCTZ) 12.5 mg for a further 6 weeks. Twenty-four-hour ambulatory blood pressure monitoring showed that telmisartan plus HCTZ (n=448) and amlodipine plus HCTZ (n=424) changed systolic blood pressure for the last 6 hours of the dosing interval by -18.3 and -17.4 mm Hg, respectively (p=0.2520). Over the 24-hour period, telmisartan plus HCTZ was superior (-19.3 and -17.2 mm Hg, respectively; p=0.001) and provided higher systolic control rates (65.9% and 58.3%, respectively; p=0.0175). Adverse events (41.2% and 53.7%, respectively) and discontinuations (5.0% and 11.3%, respectively) were lower (p<0.0001) with telmisartan than with amlodipine, mainly due to peripheral edema (1.2% and 24.3%, respectively).
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Neldam et al. (2006) conducted an RCT in systolic hypertension (n=872). Telmisartan plus HCTZ vs. Amlodipine 5-10 mg plus HCTZ 12.5 mg was evaluated on change in systolic blood pressure for the last 6 hours of the dosing interval (p=0.2520). Telmisartan plus HCTZ was superior to amlodipine plus HCTZ in reducing 24-hour systolic blood pressure (-19.3 vs -17.2 mm Hg; p=0.001) and had fewer adverse events (41.2% vs 53.7%; p<0.0001).
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