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.