Saturday, January 30, 2010
Telmisartan, a 2nd-generation of ARB
Telmisartan vs Valsartan
An 8-week course of once-daily TELMISARTAN 80 mg produced greater decreases in diastolic blood pressure during the last 6 hours of 24-hour ambulatory blood pressure monitoring than did once daily valsartan 80 mg (-7.5 millimeters mercury (mmHg) versus -5.2 mmHg, respectively; p less than 0.01), with both drugs showing good tolerability, according to a randomized, open-label, blinded primary end-point trial (n=426).
Littlejohn T, Mroczek W, Marbury T, et al: A prospective, randomized open-label trial comparing telmisartan 80 mg with valsartan 80 mg in patients with mild to moderate hypertension using ambulatory blood pressure monitoring. Can J Cardiol 2000; 16(9):1123-1132.
Telmisartan vs Ramipril
No significant differences were found in the rates of major cardiovascular events between treatment with telmisartan, ramipril, or the combination of the two in patients with coronary, peripheral, or cerebrovascular disease, or with high-risk diabetic patients with evidence of end-organ damage in the randomized, controlled, non-inferiority ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) study, although combination-therapy treatment led to a higher risk of adverse events.
More patients discontinued treatment in the ramipril group vs the telmisartan group due to cough (4.2% vs 1.1%, p less than 0.001) and angioedema (0.3% vs 0.1%, p=0.01) while more patients discontinued treatment in the telmisartan group vs the ramipril group due to hypotensive symptoms (2.7% vs 1.7%, p less than 0.001). In the combination-therapy group, more patients discontinued treatment compared to the ramipril group due to hypotensive symptoms (4.8% vs 1.7%, p less than 0.001), syncope (0.3% vs 0.2%, p=0.03), diarrhea (0.5% vs 0.1%, p less than 0.001), and renal impairment (1.1% vs 0.7%, p less than 0.001)
Yusuf S, Teo KK, Pogue J, et al: Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008; 358(15):1547-1559.
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