A systematic review and meta-analysis of telmisartan versus valsartan in the management of essential hypertension

Abstract

This was a systematic assessment of the efficacy and safety of telmisartan and valsartan for the management of blood pressure (BP) in patients with essential hypertension. The authors reviewed randomized controlled trials (RCTs) and quasi-RCTs comparing telmisartan and valsartan for the management of essential hypertension in which the participants were followed for at least 6 weeks. When a metaanalysis was possible, included studies were analyzed by Review Manager 5.0 provided by Cochrane Collaboration Group. Statistics were calculated as weight mean differences (WMDs) and relative risk with a random-effect model. A total of 6 RCTs with 3762 patients were included in this metaanalysis. When the authors combined data from all treatment categories as a group, no difference was found between telmisartan and valsartan in reduction of systolic BP and diastolic BP. In subgroup analysis, telmisartan showed a significant benefit on lowering systolic BP and diastolic BP (WMD, -2.88; 95% confidence interval [CI], -5.03 to -0.73; P<0.01; and WMD,-1.73; 95% CI, -2.47 to -0.98; P<0.01; respectively). It was found that telmisartan had a higher rate of management of clinical BP compared with valsartan (relative risk, 1.09; 95% CI, 1.00-1.19; P=0.05). No difference was found in the incidence of adverse events. Telmisartan's BP-lowering capabilities were comparable to those of valsartan in monotherapy. When combined with hydrochlorothiazide, telmisartan was more effective than valsartan. Telmisartan had the same safety in the treatment of essential hypertensive patients in comparison with valsartan.

Figure 1

Funnel plot of end points. (A) Systolic blood pressure control. (B) Diastolic blood pressure control. (C) Target blood pressure achievement. (D) Adverse events. HCTZ indicates hydrochlorothiazide; MD, mean difference; RR, relative risk; SE, standard error.

Figure 2

Comparison of telmisartan vs valsartan on systolic blood pressure control. CI indicates confidence interval; df, degrees of freedom; HCTZ, hydrochlorothiazide; IV, intravenous; SD, standard deviation.

Figure 3

Comparison of telmisartan vs valsartan on diastolic blood pressure control. CI indicates confidence interval; df, degrees of freedom; HCTZ, hydrochlorothiazide; IV, intravenous; SD, standard deviation.

Figure 4

Comparison of telmisartan vs valsartan on target blood pressure achievement. CI indicates confidence interval; df, degrees of freedom; HCTZ, hydrochlorothiazide; M‐H, Mantel‐Haenszel test.

Figure 5

Comparison of telmisartan vs valsartan on common adverse events. CI indicates confidence interval, df, degrees of freedom; M‐H, Mantel‐Haenszel test.