Telmisartan - A review of its use in hypertension

Telmisartan is an angiotensin II receptor antagonist that is highly selecti ve for type I angiotensin II receptors. It was significantly more effective than placebo in large (n > 100), double-blind, randomised, multicentre cli nical trials in patients with mild to moderate hypertension. Telmisartan 20 to 160mg once daily produced mean reductions in supine trough systolic blo od pressure and diastolic blood pressure of up to 15.5 and 10.5mm Hg, respe ctively. Maximum blood pressure reduction occurred with a dosage of 40 to 8 0 mg/day. Telmisartan 40 to 120 mg/day was as effective as amlodipine 5 to 10 mg/day or atenolol 50 to 100 mg/day in dose-titration studies. Telmisartan 20 to 1 60 mg/day was generally similar in efficacy to enalapril 5 to 20 mg/day or lisinopril 10 to 40 mg/day in both titration-to-response and other studies. Hydrochlorothiazide was coadministered in most of the titration-to-respons e studies if patients remained hypertensive. Telmisartan 80 mg/day was more effective than submaximal dosages of losarta n (50 mg/day) or valsartan (80 mg/day) and was as effective as a fixed-dose combination of losartan 50mg plus hydrochlorothiazide 12.5mg over the last 6 hours of the dosage interval and the whole 24-hour postdose interval. In patients with severe hypertension, telmisartan 80 to 160 mg/day was as eff ective as enalapril 20 to 40 mg/day (both agents could be titrated and comb ined sequentially with hydrochlorothiazide 25mg and amlodipine 5mg). The addition of hydrochlorothiazide to telmisartan was more effective than each agent alone at lowering blood pressure in patients with hypertension. Telmisartan was well tolerated in patients with mild to moderate hypertensi on and was significantly less likely to cause persistent, dry cough than li sinopril. Conclusion: Telmisartan is an effective antihypertensive agent with a toler ability profile similar to that of placebo. Comparative data have shown tel misartan to be as effective as other major classes of antihypertensive agen ts at lowering blood pressure. Compared with lisinopril, telmisartan is ass ociated with a significantly lower incidence of dry, persistent cough. Ther efore, telmisartan is a useful therapeutic option in the management of pati ents with hypertension.