Overview of telmisartan for blood pressure reduction among angiotensin II receptor blockers: A meta-analysis of head-to-head randomized trials

A meta-analysis of randomized trials of telmisartan versus active controls for insulin resistance in hypertensive patients

To determine whether telmisartan improves insulin resistance compared with other antihypertensive drugs, we performed a meta-analysis of randomized controlled trials (RCTs) of telmisartan. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through December 2013. Eligible studies were prospective RCTs of telmisartan versus other antihypertensive drugs, enrolling individuals with hypertension and reporting insulin levels and/or homeostasis model assessment-insulin resistance (HOMA-IR) as outcomes. Of 67 potentially relevant articles screened initially, 33 reports of RCTs enrolling a total of 2033 patients with hypertension were identified and included. Pooled analyses of only the eight double-blind-design trials demonstrated statistically significant reductions in percent changes of insulin levels (mean difference, -5.19%; 95% confidence interval, -8.94% to -1.43%; P = .007) and HOMA-IR (-15.34%; -26.39% to -4.28%; P = .007) with telmisartan relative to other antihypertensive drugs. When data from all the 33 trials were pooled, telmisartan was associated with statistically significant reductions in percent changes of insulin levels (-10.92%; -15.60% to -6.23%; P < .00001) and HOMA-IR (-15.89%; -22.01% to -9.78%; P < .00001) relative to other antihypertensive drugs. In conclusion, telmisartan appears to significantly improve insulin resistance compared with other antihypertensive drugs in patients with hypertension.

A meta-analysis of randomized trials of telmisartan versus losartan for reduction of ambulatory blood pressure

A previous meta-analysis of a few randomized controlled trials (RCTs) suggests a significant reduction in ambulatory blood pressure (BP) with telmisartan as compared with losartan monotherapy. We performed an updated meta-analysis of RCTs of telmisartan versus losartan therapy for reduction of ambulatory BP in patients with hypertension. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through July 2012 using PubMed and OVID. Eligible studies were RCTs of telmisartan versus valsartan therapy enrolling individuals with hypertension and reporting ambulatory BP as an outcome. For each study, data regarding changes from baseline in ambulatory (24 h, last 6 h, morning, daytime and nighttime) BP in both the telmisartan and losartan groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Of 34 potentially relevant articles screened initially, 9 reports of RCTs enrolling a total of 2409 patients with hypertension were identified and included. Pooled analysis suggested significant reductions in all of 24-h (MD of systolic/diastolic BP, -2.09/-1.57 mm Hg; 95% CI, -3.39/-2.32 to -0.79/-0.82 mm Hg), last 6-h (-2.96/-2.15 mm Hg; -3.80/-2.72 to -2.13/-1.59 mm Hg), morning (-2.71/-2.37 mm Hg; -3.73/-3.33 to -1.69/-1.41 mm Hg), daytime (-1.74/-1.73 mm Hg; -3.27/-2.84 to -0.20/-0.62 mm Hg) and nighttime BP (-2.70/-2.08 mm Hg; -4.07/-3.24 to -1.33/-0.92 mm Hg) among patients randomized to telmisartan versus losartan therapy. In conclusion, telmisartan therapy appears to reduce ambulatory BP more than losartan therapy in patients with hypertension.