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003

SUSTAINED ANTIHYPERTENSIVE ACTIVITY OF TELMISARTAN VS VALSARTAN ON AMBULATORY BLOOD PRESSURE

Y Lacourciere, L Poirier, JM Krzesinski, WB White, G Davidai, L Oostvogel, H Schumacher

Quebec City, Quebec; Liege, Belgium; Farmington, Connecticut, USA

OBJECTIVE: Early-morning BP surge and 24-h mean BP are linked to target-organ damage and cardiovascular events. The objective was to compare the antihypertensive efficacy of telmisartan vs valsartan in the last 6 h of the dosing interval and after a missed dose.

DESIGN AND METHODS: Hypertensive patients (seated cuff DBP 95-109 mmHg, 24-h mean DBP ³85 mmHg) received once daily telmisartan 40/80 mg or valsartan 80/160 mg for 8 weeks in 2 identical multicenter, double-blind, parallel-group, forced-titration trials. The higher dose was given after 2 weeks of low-dose therapy. After 4 weeks of higher-dose therapy, 1 day’s double-blind active therapy or placebo (missed dose) was given to patients in each study arm. After another 2 weeks of active therapy, patients previously given placebo received active therapy, and vice versa. ABPM was performed for 24 h at baseline and after the 2 ‘active/missed dose’ days.

RESULTS: Data from the 2 trials were combined as prospectively planned. After active therapy, last 6-h mean DBP was reduced by 7.6±7.9 mmHg from 88.1±8.1 mmHg with telmisartan (n=447) vs 5.8±7.8 mmHg from 87.1±7.5 mmHg with valsartan (n=430) (p=0.0044, adjusted for baseline, study, and treatment-by-study interaction). After the missed dose, 24-h mean DBP was reduced by 7.2±6.5 mmHg from 93.4±6.2 mmHg with telmisartan (n=437) vs 5.5±6.2 mmHg from 92.8±5.8 mmHg with valsartan (n=431) (p=0.0004). Absence of treatment-by-study interaction indicates that pooling of trial data is appropriate. All 24 hourly mean reductions with telmisartan were greater than with valsartan. Both treatments were equally well tolerated.

CONCLUSION: DBP reduction in the last 6 h of the once-daily dosing interval and 24-h mean DBP control when a dose is missed are significantly superior with telmisartan than with valsartan. Thus, telmisartan due to its longer half-life offers more sustained BP control, especially at the end of the dosing period and provides sustained efficacy in poorly compliant patients.

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