1. ¹Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
2. ²Medical Department, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
3. ³Medical Data Services, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany

Correspondence: Professor WB White, Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA. E-mail: Wwhite@NSO1.uchc.edu

Received 30 November 2008; Revised 2 March 2009; Accepted 6 March 2009; Published online 9 April 2009.

Abstract

The antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg, were assessed in a pooled analysis from two large trials with identical study designs in patients with stage 1–2 hypertension. The trials were double-blind with a 4:4:1 randomization scheme to compare once-daily telmisartan 80 mg and HCTZ 25 mg versus once-daily valsartan 160 mg and HCTZ 25 mg versus once-daily placebo on reductions in clinic blood pressure (BP). The primary end point was changes from baseline in BP at the end of 8 weeks. In total, 2121 patients were randomized (telmisartan–HCTZ, 942, valsartan–HCTZ, 952, and placebo, 227) and had baseline seated BPs of 154/102 and 155/102 mm Hg in the two studies, respectively. Changes from baseline in BP after administration of telmisartan–HCTZ (-24.5/-18.0 mm Hg) were significantly greater than for both placebo (-4.1/-6.5 mm Hg) and valsartan–HCTZ (-22.3/-16.8 mm Hg) (versus placebo, P<0.0001 for systolic and diastolic BP; versus valsartan–HCTZ, P=0.0004 for systolic BP and P=0.0019 for diastolic BP). Adverse event rates were higher in the placebo group than in the active treatment groups (placebo, 41%, telmisartan–HCTZ, 30%, and valsartan–HCTZ, 30%, P<0.05). These data confirm that telmisartan–HCTZ at doses of 80/25 mg lowered systolic and diastolic BP to a greater extent than valsartan–HCTZ at doses of 160/25 mg in stage 1–2 hypertension. The magnitude of the BP-lowering effect provides support for the use of angiotensin receptor blockers with higher doses of a thiazide diuretic (25 mg) to improve hypertension control.