January 1, 2004Hypertension Research39 citationsOpen Access

Practical Efficacy of Telmisartan for Decreasing Morning Home Blood Pressure and Pulse Wave Velocity in Patients with Mild-to-Moderate Hypertension

HUHaruhito A. Uchida YNYoshio Nakamura MKMasanobu Kaihara

Structured PICO

Does telmisartan 40 mg/day reduce morning home blood pressure and pulse wave velocity in patients with mild-to-moderate hypertension?

Population

24 enrolled (22 analyzed) patients with mild-to-moderate hypertension (office blood pressure >140 and/or 90 mmHg), mean age 61.9, 64% male, based in Japan. Excluded secondary hypertension, cerebrovascular damage, cardiac infarction, or kidney dysfunction ≥Cr 2.0 mg/dl.

Intervention

Telmisartan 40 mg orally once daily for 3 months. Prior ARBs (losartan 50 mg/day) were discontinued and replaced with telmisartan; other prior antihypertensives were continued.

Outcome

Change in morning home blood pressure (MHBP), office blood pressure (OBP), and brachial-ankle pulse wave velocity (baPWV) at 3 monthssurrogate

Telmisartan 40 mg/day effectively reduces morning home blood pressure and arterial stiffness in patients with mild-to-moderate hypertension, including those inadequately controlled on losartan 50 mg/day.

Limitations

Results of group L were from subjects who were administered losartan 50mg/day and whose OBP was more than 140/90mmHg (inadequate prior dose)

Abstract

The current guideline-recommended blood pressure values are difficult to maintain in general practice, partly due to the lack of ideal anti-hypertensive agents. Since morning hypertension has a high correlation with cardiovascular events, expectations that telmisartan, a long-acting angiotensin-II type-1 receptor blocker (ARB), can improve cardiovascular mortality are high. In this study, the efficiency of telmisartan in reducing morning hypertension and pulse wave velocity (PWV) as a practical surrogate endpoint was investigated. Seventeen unsupervised and 7 untreated hypertensive patients were prescribed telmisartan 40 mg/day for 3 months. Medication already prescribed upon enrollment in this study was continued, with the exception of ARBs (all of which turned out to be losartan 50 mg/day), which were discontinued and replaced with telmisartan. Morning home blood pressure (MHBP), office blood pressure (OBP), and brachial-ankle PWV (baPWV) were investigated in a prospective fashion. A stratified analysis was performed regarding previous use (group L) or non-use (group N) of losartan. Over a 3-month period, telmisartan was found to significantly reduce both OBP (from 153+/-13/85+/-9 to 141+/-17/80+/-7 mmHg (p <0.01)) and MHBP (from 153+/-23/93+/-11 to 137+/-22/82+/-10 mmHg (p <0.001)). Surprisingly, 7 patients (70%) from group L achieved an OBP of less than 140/90 mmHg by simply changing their medication to telmisartan. Furthermore, baPWV fell significantly from 1,892+/-334 cm/s to 1,672+/-324 cm/s (p <0.01), which was greater than the change in baPWV estimated by OBP reduction. Here it must be mentioned that there were no significant differences between group L and group N in the courses of blood pressures and baPWV. In conclusion, telmisartan 40 mg/day was found to be effective for reducing MHBP and arterial wall stiffness in patients with mild-to-moderate hypertension, and thus may also be effective for improving cerebrocardiovascular mortality.

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