Telmisartan versus ramipril in 24-h ambulatory blood pressure: A pooled analysis of 2 prospective, randomized trials in mild-to-moderate hypertensive patients

To compare the antihypertensive efficacy of telmisartan and ramipril in the last 6-h of the dosing interval. Blood pressure control over a 24-h period is fundamental to achieving optimal risk reduction. Antihypertensives with shorter durations of action may lose efficacy towards the end of the dosing interval, despite good control of office blood pressure. Data from two 14-week, prospective, open-label, blinded-endpoint, randomized studies of identical design were pooled. Patients had seated SBP 95–109 mmHg, seated DBP <180 mmHg, and 24-h mean DBP ≥85 mmHg. They were started on telmisartan 40 mg (n=802) or ramipril 2.5 mg (n=811), force titrated to telmisartan 80 mg or ramipril 5 mg after 2 weeks. At Week 8, ramipril was further up titrated to 10 mg. Blood pressure was measured using ABPM. At 14 weeks, telmisartan 80 mg was superior to ramipril 10 mg in the last 6-h mean ambulatory SBP/DBP (adjusted mean reductions ±SE from baseline 12.0±0.43/8.7±0.33 versus 7.9±0.43/5.5±0.32 mmHg respectively, P<0.0001). Telmisartan was also superior to ramipril on 24-h, daytime and night-time mean ambulatory SBP and DBP (P<0.001). Changes in cuff trough seated blood pressure were also significantly greater with telmisartan. Both drugs were well tolerated and no serious drug-related adverse events occurred. Telmisartan 80 mg afforded superior ambulatory blood pressure reductions in the last 6-h of the dosing interval and in the 24-h mean compared with ramipril 10 mg. The magnitude of the benefit was greatest towards the end of the dosing interval.