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Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials

Journal of Human Hypertension volume 23, pages 339–349 (2009)Cite this article

Abstract

Telmisartan and angiotensin-converting enzyme inhibitors (ACEIs) are both effective and widely used antihypertensive drugs targeting renin–angiotensin–aldosterone system. The study aimed to estimate the efficacy and tolerability of telmisartan in comparison with different ACEIs as monotherapy in the treatment of hypertension. Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. A random-effect model was used to account for heterogeneity among trials. Twenty-eight randomized controlled trials involving 5157 patients were ultimately identified out of 721 studies. Telmisartan had a greater diastolic blood pressure (DBP) reduction than enalapril (weighted mean difference (WMD) 1.82, 95% confidence interval (CI) 0.66–2.99), ramipril (WMD 3.09, 95% CI 1.94–4.25) and perindopril (WMD 1.48, 95% CI 0.33–2.62). Telmisartan also showed a greater DBP response rate than enalapril (relative risk (RR) 1.15, 95% CI 1.05–1.26), ramipril (RR 1.34, 95% CI 1.11–1.61) and perindopril (RR 1.22, 95% CI 1.05–1.41). There was no statistical difference in DBP reduction or therapeutic response rate between telmisartan and lisinopril (WMD −0.30, 95% CI −0.65 to 0.05; RR 0.99, 95% CI 0.80–1.23, respectively). Telmisartan had fewer drug-related adverse events than enalapril (RR 0.57, 95% CI 0.44–0.74), ramipril (RR 0.44, 95% CI 0.26–0.75), lisinopril (RR 0.70, 95% CI 0.56–0.89) and perindopril (RR 0.52, 95% CI 0.28–0.98). The meta-analysis indicates that telmisartan provides a superior BP control to ACEIs (enalapril, ramipril and perindopril) and has fewer drug-related adverse events and better tolerability in hypertensive patients.

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References

  1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117: e25–146.

    PubMed  Google Scholar 

  2. Wang JG, Staessen JA, Franklin SS, Fagard R, Gueyffier F . Systolic and diastolic blood pressure lowering as determinants of cardiovascular outcome. Hypertension 2005; 45: 907–913.

    Article  CAS  Google Scholar 

  3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.

    Article  CAS  Google Scholar 

  4. Neutel JM, Smith DHG . Dose response and antihypertensive efficacy of the AT1 receptor antagonist telmisartan in patients with mild to moderate hypertension. Adv Ther 1998; 15: 206–217.

    CAS  Google Scholar 

  5. Smith DH, Matzek KM, Kempthorne-Rawson J . Dose response and safety of telmisartan in patients with mild to moderate hypertension. J Clin Pharmacol 2000; 40: 1380–1390.

    Article  CAS  Google Scholar 

  6. Lacourciere Y . The incidence of cough: a comparison of lisinopril, placebo and telmisartan, a novel angiotensin II antagonist. Telmisartan Cough Study Group. Int J Clin Pract 1999; 53: 99–103.

    CAS  PubMed  Google Scholar 

  7. Wienen W, Entzeroth M, van Meel JCA, Stangier J, Busch U, Ebner T et al. A review on telmisartan:a novel, long-acting angiotensin II-receptor antagonist. Cardiovasc Drug Rev 2000; 18: 127–154.

    Article  CAS  Google Scholar 

  8. Neutel J, Smith DH . Evaluation of angiotensin II receptor blockers for 24-hour blood pressure control: meta-analysis of a clinical database. J Clin Hypertens 2003; 5: 58–63.

    Article  CAS  Google Scholar 

  9. Xi GL, Cheng JW, Lu GC . Meta-analysis of randomized controlled trials comparing telmisartan with losartan in the treatment of patients with hypertension. Am J Hypertens 2008; 21: 546–552.

    Article  CAS  Google Scholar 

  10. Baguet JP, Legallicier B, Auquier P, Robitail S . Updated meta-analytical approach to the efficacy of antihypertensive drugs in reducing blood pressure. Clin Drug Investig 2007; 27: 735–753.

    Article  CAS  Google Scholar 

  11. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358: 1547–1559.

    Article  CAS  Google Scholar 

  12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1–12.

    Article  CAS  Google Scholar 

  13. Smith DH, Neutel JM, Lacourciere Y, Kempthorne-Rawson J . Prospective, randomized, open-label, blinded-endpoint (PROBE) designed trials yield the same results as double-blind, placebo-controlled trials with respect to ABPM measurements. J Hypertens 2003; 21: 1291–1298.

    Article  CAS  Google Scholar 

  14. Deeks JJ, Higgins JPT, Altman DG (eds) Analysing and presenting results. In: Higgins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. John Wiley & Sons, Ltd: Chichester, UK, 2006, pp 116–122.

    Google Scholar 

  15. Smith DHG, Neutel JM, Morgenstern P . Once-daily telmisartan compared with enalapril in the treatment of hypertension. Adv ther 1998; 15: 229–240.

    CAS  Google Scholar 

  16. Chen JH, Cheng JJ, Chen CY, Chiou HC, Huang TY, Tsai CD et al. Comparison of the efficacy and tolerability of telmisartan 40 mg vs. enalapril 10 mg in the treatment of mild-to-moderate hypertension: a multicentre, double-blind study in Taiwanese patients. Int J Clin Pract 2004; 58: 29–34.

    Article  Google Scholar 

  17. Amerena J, Pappas S, Ouellet JP, Williams L, O'Shaughnessy D . ABPM comparison of the anti-hypertensive profiles of telmisartan and enalapril in patients with mild-to-moderate essential hypertension. J Int Med Res 2002; 30: 543–552.

    Article  CAS  Google Scholar 

  18. Hannedouche T, Chanard J, Baumelou B . Evaluation of the safety and efficacy of telmisartan and enalapril, with the potential addition of frusemide, in moderate-renal failure patients with mild-to-moderate hypertension. J Renin Angiotensin Aldosterone Syst 2001; 2: 246–254.

    Article  CAS  Google Scholar 

  19. Alcocer L, Fernandez-Bonetti P, Campos E, Dominguez-Henkel R, de la Fuente JJ, Segovia-Ayala C . Clinical efficacy and safety of telmisartan 80 mg once daily compared with enalapril 20 mg once daily in patients with mild-to-moderate hypertension: results of a multicentre study. Int J Clin Pract Suppl 2004; 58: 23–28.

    Article  Google Scholar 

  20. Karlberg BE, Lins LE, Hermansson K . Efficacy and safety of telmisartan, a selective AT1 receptor antagonist, compared with enalapril in elderly patients with primary hypertension. TEES Study Group. J Hypertens 1999; 17: 293–302.

    Article  CAS  Google Scholar 

  21. Andreeva GF, Gorbunov VM, Aivazian TA, Isaikina O, Voronina VP, Lerman OV . Effect of telmisartan on the psychological state and quality of life in stable hypertension patients. Exp Clin Pharmacol 2004; 67: 36–40.

    CAS  Google Scholar 

  22. Neutel JM, Smith DH, Reilly PA . The efficacy and safety of telmisartan compared to enalapril in patients with severe hypertension. Int J Clin Pract 1999; 53: 175–178.

    CAS  PubMed  Google Scholar 

  23. Lu YZ, Ji NJ, Luo WY . Efficacy and safety of telmisartin and enalapril in the threapy of senile patients with hypertension. Chin J Mod Appl Pharm 2007; 24: 425–427.

    CAS  Google Scholar 

  24. Huang CG, Huang Y, Guo WB . Clinical investigation on effect of telmisartan on reversing left ventricular hypertrophy in patients with hypertension. J Clin Research 2007; 24: 1667–1669.

    CAS  Google Scholar 

  25. Chen X, Tan ZQ, He Z . Comparison of telmisartan, enalapril and amlodipine in the treatment of hypertensive patients with diabetic nephropathy. Chin J Cardiovasc Rehabil Med 2004; 13: 270–271.

    Google Scholar 

  26. Lewandowski J, Abramczyk P, Dobosiewicz A, Bidiuk J, Sinski M, Gaciong Z . The effect of enalapril and telmisartan on clinical and biochemical indices of sympathetic activity in hypertensive patients. Clin Exp Hypertens 2008; 30: 423–432.

    Article  CAS  Google Scholar 

  27. Williams B, Gosse P, Lowe L, Harper R . The prospective, randomized investigation of the safety and efficacy of telmisartan versus ramipril using ambulatory blood pressure monitoring (PRISMA I). J Hypertens 2006; 24: 193–200.

    Article  CAS  Google Scholar 

  28. Poirier L, de Champlain J, Larochelle P, Lamarre-Cliche M, Lacourciere Y . A comparison of the efficacy and duration of action of telmisartan, amlodipine and ramipril in patients with confirmed ambulatory hypertension. Blood Press Monit 2004; 9: 231–236.

    Article  Google Scholar 

  29. Lacourciere Y, Neutel JM, Davidai G, Koval S . A multicenter, 14-week study of telmisartan and ramipril in patients with mild-to-moderate hypertension using ambulatory blood pressure monitoring. Am J Hypertens 2006; 19: 104–112.

    Article  CAS  Google Scholar 

  30. Celik T, Iyisoy A, Kursaklioglu H, Yilmaz MI, Kose S, Kilic S et al. The comparative effects of telmisartan and ramipril on P-wave dispersion in hypertensive patients: a randomized clinical study. Clin Cardiol 2005; 28: 298–302.

    Article  Google Scholar 

  31. Schmieder RE, Delles C, Mimran A, Fauvel JP, Ruilope LM . Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes. Diabetes Care 2007; 30: 1351–1356.

    Article  CAS  Google Scholar 

  32. Wang Y . Comparison of the Effect of Telmisartan and Ramipril in Essential Hypertension. Modern Chinese Doctors 2007; 45: 10–11.

    CAS  Google Scholar 

  33. Neutel JM, Frishman WH, Oparil S, Papademitriou V, Guthrie G . Comparison of telmisartan with lisinopril in patients with mild-to-moderate hypertension. Am J Ther 1999; 6: 161–166.

    Article  CAS  Google Scholar 

  34. Stergiou GS, Efstathiou SP, Roussias LG, Mountokalakis TD . Blood pressure- and pulse pressure-lowering effects, trough:peak ratio and smoothness index of telmisartan compared with lisinopril. J Cardiovasc Pharmacol 2003; 42: 491–496.

    Article  CAS  Google Scholar 

  35. Sengul AM, Altuntas Y, Kurklu A, Aydin L . Beneficial effect of lisinopril plus telmisartan in patients with type 2 diabetes, microalbuminuria and hypertension. Diabetes Res Clin Pract 2006; 71: 210–219.

    Article  CAS  Google Scholar 

  36. Ghiadoni L, Magagna A, Versari D, Kardasz I, Huang Y, Taddei S et al. Different effect of antihypertensive drugs on conduit artery endothelial function. Hypertension 2003; 41: 1281–1286.

    Article  CAS  Google Scholar 

  37. Nalbantgil S, Ozerkan F, Yilmaz H, Gurgun C, Zoghi M et al. The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension. Int J Clin Pract Suppl 2004; 58: 50–54.

    Article  Google Scholar 

  38. Ragot S, Meunier A, Poterre M, Bourkaib R, Herpin D . Evaluation of blood pressure self-monitoring of the residual efficacy of telmisartan compared to perindopril. Arch Cardiovasc Diseases 2002; 95: 738–742.

    CAS  Google Scholar 

  39. Remkova A, Kratochvil'ova H, Durina J . Impact of the therapy by renin-angiotensin system targeting antihypertensive agents perindopril versus telmisartan on prothrombotic state in essential hypertension. J Hum Hypertens 2008; 22: 338–345.

    Article  CAS  Google Scholar 

  40. Peng XL, Lin ZP, Zhao YS, Huang P . Effect of telmisartan on left ventricular hypertrophy in elderly patients with diabetes mellitus and essential hypertension. Chin J Geriatrics 2005; 24: 435–437.

    Google Scholar 

  41. Murray CJ, Lopez AD . Evidence-based health policy—lessons from the Global Burden of Disease Study. Science 1996; 274: 740–743.

    Article  CAS  Google Scholar 

  42. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.

    Article  Google Scholar 

  43. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003; 107: 1401–1406.

    Article  Google Scholar 

  44. Muller JE, Tofler GH, Stone PH . Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 1989; 79: 733–743.

    Article  CAS  Google Scholar 

  45. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G . Prognostic value of 24-h blood pressure variability. J Hypertens 1993; 11: 1133–1137.

    Article  CAS  Google Scholar 

  46. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G . Relationship of 24-h blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987; 5: 93–98.

    Article  CAS  Google Scholar 

  47. Israili ZH, Hall WD . Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Ann Intern Med 1992; 117: 234–242.

    Article  CAS  Google Scholar 

  48. Speirs C, Wagniart F, Poggi L . Perindopril postmarketing surveillance: a 12 month study in 47 351 hypertensive patients. Br J Clin Pharmacol 1998; 46: 63–70.

    Article  CAS  Google Scholar 

  49. White WB . Comparative effects of telmisartan in the treatment of hypertension. J Clin Hypertens 2002; 4: 20–25.

    Article  Google Scholar 

  50. The TRANSCEND Investigators. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet 2008; 372: 1174–1183.

    Article  Google Scholar 

  51. Stergiou GS, Efstathiou SP, Roussias LG, Mountokalakis TD . Intraindividual blood pressure responses to angiotensin-converting enzyme inhibition and angiotensin receptor blockade. J Clin Hypertens 2005; 7: 18–23.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Han-xi Zheng for her help in Russian translation and Wen Chen for his help in statistical analysis. This study was supported by National Natural Science Foundation of China (no. 30772092).

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  1. Z Zou and G-L Xi: These authors contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China

    Z Zou, H-B Yuan, Q-F Zhu & X-Y Shi

  2. Center for New Drug Evaluation, Institute of Basic Medical Science, Second Military Medical University, Shanghai, People's Republic of China

    G-L Xi

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Correspondence to X-Y Shi.

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Zou, Z., Xi, GL., Yuan, HB. et al. Telmisartan versus angiotension-converting enzyme inhibitors in the treatment of hypertension: a meta-analysis of randomized controlled trials. J Hum Hypertens 23, 339–349 (2009). https://doi.org/10.1038/jhh.2008.132

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