Effects of telmisartan on office and 24-hour ambulatory blood pressure: an observational study in hypertensive patients managed in primary care

Abstract

Purpose: Although elevated blood pressure (BP) predicts future cardiovascular events, recommended BP targets often is not reached in the general community. In a clinical real-life setting we evaluated BP impact and tolerability of the angiotensin-II receptor blocker telmisartan in patients with essential hypertension.

Patients and methods: Patients in this observational study not at target BP started or switched to telmisartan monotherapy (40 or 80 mg) or a fixed-dose combination of telmisartan and hydrochlorothiazide (HCT) 80 mg/12.5 mg. Office and 24-hour ambulatory BP (AMBP) were measured before and after 8 weeks of treatment and physicians reported perceived drug efficacy and tolerability as "Very good", "Good", "Moderate" or "Bad".

Results: 100 patients (34% female, 60 years, BMI 29.4 kg/m(2), mean office BP 159/92 mmHg) of whom 38% were treatment naïve and 30%, 17%, 9% and 6% respectively were on 1, 2, 3 or 4 BP-lowering drugs, completed 8 weeks of treatment. The proportion of patients with office BP < 140/90 mmHg increased from 3% to 54% for systolic (P < 0.001), 38% to 75% for diastolic (P < 0.001), and 2% to 45% for systolic and diastolic BP (P < 0.001). A significant effect on BP levels was seen in patients being either treatment naïve or on 1 to 3 BP-lowering drugs at study entry, whereas no BP improvement occurred in those who switched from 4 drugs. Overall, mean 24-hour AMBP was reduced from 141/85 to 131/79 mmHg (P < 0.001). Drug efficacy and tolerability were perceived as "Very good" or "Good" by 44%/34% and 66%/27%, respectively. No drug discontinuations or serious adverse events were observed.

Conclusions: In this observational study, telmisartan 40 to 80 mg, or the fixed-dose combination telmisartan 80 mg/HCT 12.5 mg, significantly increased the number of patients reaching target BP < 140/90 mmHg if treatment naïve or previously receiving 1 to 3 BP-lowering drugs. The BP reduction achieved was sustained for 24-hour and treatment tolerability was high.

Keywords: 24-hour ambulatory blood pressure; efficacy; observational study; telmisartan; tolerability.

Figure 1

24-hour ambulatory BP incl. mean ± SD at baseline and study end in A) total cohort (n = 69); and according to number of BP-lowering drugs at baseline: B) none (n= 31), C) 1 (n = 17), D) 2 (n = 9) and E) 3 or 4 (n = 12) drugs. Notes: — Baseline hourly sys BP, ... 8-weeks hourly sys BP, --- Baseline hourly dia BP, -..- 8-weeks hourly dia BP, • Baseline 24-hour sys BP, ○ 8-weeks 24-hour sys BP, ▾ Baseline 24-hour dia BP, ▿ 8-weeks 24-hour dia BP, *P < 0.05, ***P < 0.001, ^§P = 0.085. Abbreviations: sys, systolic; BP, blood pressure; dia, diastolic.