Meta-analysis of randomized controlled trials comparing telmisartan with losartan in the treatment of patients with hypertension.
BACKGROUND
Hypertension is a major risk factor for cardiovascular disease, and data regarding the efficacy and tolerability of telmisartan compared with losartan on blood pressure (BP) control in patients with hypertension.


METHODS
Pertinent studies were selected through extensive searches of PubMed (1966 to 29 December 2007), Embase (1980 to 29 December 2007), and the Cochrane library (29 December 2007). Randomized clinical trials comparing telmisartan with losartan in patients with hypertension were selected using predefined criteria. The main efficacy measures were reduction in diastolic and systolic BP (DBP and SBP), and therapeutic response of DBP and SBP. The pooled estimates were carried out using RevMan version 4.2 software.


RESULTS
Eleven studies involving 1,832 patients were included in the analysis. Ten trials with 1,792 patients reported reduction in clinic BP; six trials with 1,163 patients reported ambulatory BP reduction; seven trials with 1,675 patients reported therapeutic response of BP. Funnel plots indicated that one trial had true heterogeneity. Use of telmisartan resulted in a significant reduction in clinic DBP (weighted mean difference 1.52, 95% confidence interval (CI) 0.85-2.19) and SBP (2.77, 1.90-3.63) when compared with losartan. There was also a significant reduction in 24-h mean ambulatory DBP (2.49, 0.56-4.42) and SBP (2.47, 0.40-4.55) with telmisartan as compared to losartan. There was also a significant increase in therapeutic response of DBP (relative risk (RR) 1.14, 1.04-1.23) and SBP response (1.10, 1.01-1.20) with telmisartan as compared to losartan. Both telmisartan and losartan were well tolerated.


CONCLUSIONS
In comparison with losartan, telmisartan provides superior control of BP and has no association with increased risk of adverse events.
Xi
Gui-Lin
GL
Center for New Drug Evaluation, Second Military Medical University, Shanghai, China.
Cheng
Jin-Wei
JW
Lu
Guo-Cai
GC
D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D001565:Benzoates / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D000077333:Telmisartan; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D019808:Losartan; D000077333:Telmisartan