Meta-analysis of randomized trials of telmisartan vs. valsartan therapy for blood pressure reduction

Hypertens Res. 2013 Jul;36(7):627-33. doi: 10.1038/hr.2012.233. Epub 2013 Jan 24.

Takagi H1, Niwa M, Mizuno Y, Goto SN, Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.

1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. kfgth973@ybb.ne.jp

Abstract

We performed an updated meta-analysis of telmisartan vs. valsartan therapy for the reduction of BP in hypertensive patients. For each study, the data regarding changes from baseline to final clinic systolic BP (SBP) and diastolic BP (DBP) in both the telmisartan and valsartan groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Seventeen prospective randomized clinical trials, including a total of 5422 patients with hypertension, were included. Pooled analysis suggested significant differences in BP reductions among the patients randomized to telmisartan vs. valsartan therapy (MD for SBP, -2.04 mm Hg; 95% CI, -2.80 to -1.28 mm Hg; P<0.00001; MD for DBP, -1.08 mm Hg; 95% CI, -1.55 to -0.62 mm Hg; P<0.00001). When data from the monotherapy and combination therapy (with hydrochlorothiazide) trials were pooled separately, telmisartan therapy was associated with a statistically significant difference in BP reductions relative to valsartan therapy in both the monotherapy and combination therapy groups. In conclusion, telmisartan therapy appears to reduce BP more than valsartan therapy in patients with hypertension.

PMID: 2334413  [PubMed - indexed for MEDLINE]

In an analysis involving one million adults in 60 prospective studies, the relationship between the reduction in BP and cardiovascular morbidity and mortality events supported that a 2-mm Hg reduction in SBP would provide about 10% lower stroke mortality and 7% lower mortality from ischemic heart disease or other vascular death without a BP threshold down to the 115⁄75 mm Hg level.13

In another study, it was suggested that a 1-mm Hg DBP reduction would be associated with a 5% reduction in the risk of coronary heart disease and an 8% reduction in the risk of stroke.