1. ¹Cardiology, University of Oklahoma, Oklahoma Cardiovascular and Hypertension Center, Oklahoma City, OK, USA
2. ²Division of Cardiology, Washington University School of Medicine, St Louis, MO, USA
3. ³Glenmark Pharmaceuticals, Mumbai, India

Correspondence: Dr SG Chrysant, Cardiology, University of Oklahoma, 5850 W Wilshire Blvd, Oklahoma City, OK 73132-4904, USA. E-mail: schrysant@yahoo.com

Received 29 July 2004; Accepted 29 September 2004; Published online 20 January 2005.

Abstract

Poorly controlled hypertension is a major risk for cardiovascular morbidity and mortality, strokes, heart failure and renal failure. Despite these devastating complications, blood pressure control of 140/90 mmHg, which is above the current standard, is very poor worldwide, accounting for 34% of hypertensive patients in the United States, and 6% in other countries. The reasons for this poor control of blood pressure include lack of aggressive treatment by physicians, especially for the systolic blood pressure, drug selection and patient compliance. The blood pressure follows a circadian rhythm and is the highest between 0600 to 1200 h, when most complications occur. Long-acting drugs that extend their action to cover this vulnerable period are preferable, especially those that block the renin–angiotensin–aldosterone system, such as ACE inhibitors and angiotensin receptor blockers, and are the most effective in controlling blood pressure and preventing or reducing its cardiovascular and renal complications. With respect to the angiotensin receptor blockers, telmisartan has been demonstrated by several studies to be the longest acting among its class of drugs and to effectively prevent the early morning rise of blood pressure.