New standards in hypertension and cardiovascular risk management: focus on telmisartan

Abstract

Blockade of the renin-angiotensin system is an important approach in managing high blood pressure, and has increasingly been shown to affect cardiovascular disease processes mediated by angiotensin II throughout the cardiovascular and renal continua. Telmisartan is an angiotensin II receptor blocker (ARB) displaying unique pharmacologic properties, including a longer half life than any other ARB, that result in large and sustained reductions of blood pressure. In patients with mild-to-moderate hypertension, telmisartan has proved superior to other antihypertensive agents (valsartan, losartan, ramipril, perindopril, and atenolol) in controlling blood pressure particularly towards the end of the dosing interval. There is also clinical evidence that telmisartan reduces left ventricular hypertrophy, reduces arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection. The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study has demonstrated that telmisartan has similar cardiovascular protective effects to ramipril in a large, high-risk patient population but was better tolerated. The powerful and sustained blood pressure control apparent in clinical trials, together with cardiovascular protection and tolerability demonstrated in ONTARGET means that telmisartan may be a preferred option for patients with hypertension.

Keywords: angiotensin II receptor blocker; cardiovascular disease; hypertension; renin–angiotensin system; telmisartan.

Figure 1

Mechanism of blockade of the renin–angiotensin system. Abbreviations: SNS, somatic nervous system; tPA, tissue plasminogen activator.

Figure 2

The cardiovascular and renal continua of disease and studies evaluating the efficacy of telmisartan. Abbreviations: ARB, angiotension II receptor blocker; FDC, fixed-dose combination; LVH, left ventricular hypertrophy.