Titre du document / Document title

Treatment of hypertension with an angiotensin II-receptor antagonist compared with an angiotensin-converting enzyme inhibitor: A review of clinical studies of telmisartan and enalapril

Auteur(s) / Author(s)

SMITH David H. G. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Integrium, Orange, California, ETATS-UNIS

Résumé / Abstract

Background: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (ATII)-receptor antagonists suppress the effects of ATII and are effective antihypertensive agents. However, the use of ACE inhibitors is sometimes associated with intolerable side effects (eg, cough, angioedema), and patients may develop a compensatory rise in ATII levels. ATII-receptor antagonists have tolerability profiles similar to that of placebo and inhibit the effects of ATII more completely by blocking the AT₁ receptor. Objective: This review summarizes clinical studies comparing the efficacy and tolerability of the ATII-receptor antagonist telmisartan with the ACE inhibitor enalapril in patients with hypertension. Methods: Randomized, controlled clinical trials comparing telmisartan with enalapril in patients with primary hypertension were identified through a PubMed search of the English-language literature from 1998 through 2001 and from bibliographic data provided by the manufacturer of telmisartan. Results: In 2 randomized, double-blind, placebo-controlled trials (total number of patients, 647), telmisartan 40 or 80 mg/d was at least as effective as enalapril 20 mg/d for lowering blood pressure (BP) in patients with mild to moderate hypertension. An open-label, titration-to-response study involving 86 patients with severe hypertension found that telmisartan 80 to 160 mg/d was as efficacious as enalapril 20 to 40 mg/d. The antihypertensive effects of telmisartan 20 to 80 mg/d and enalapril 5 to 20 mg/d were comparable in 278 elderly patients (age ≥65 years) with mild to moderate hypertension enrolled in a 26-week, double-blind, dose-titration study. A double-blind, titration-to-response study in 71 patients with moderate renal impairment and mild to moderate hypertension found equivalent reductions in BP with telmisartan 40 to 80 mg/d and enalapril 10 to 20 mg/d without any clinically relevant decline in renal function. Telmisartan tended to be better tolerated than enalapril in this study, with fewer patients experiencing treatment-related adverse events (8.9% vs 26.9%, respectively). Conclusions: Based on the literature included in this review, telmisartan and enalapril produced comparable reductions in BP in a broad range of patients with hypertension. Telmisartan appeared to have a better tolerability profile.

Revue / Journal Title

Clinical therapeutics   ISSN 0149-2918 

Source / Source

2002, vol. 24, n^o10, pp. 1484-1501 [18 page(s) (article)] (86 ref.)

Langue / Language

Anglais

Editeur / Publisher

Excerpta Medica, Belle Mead, NJ, ETATS-UNIS  (1977) (Revue)

Mots-clés anglais / English Keywords

Enzyme ; Hydrolases ; Peptidases ; Peptidyl-dipeptidases ; Cardiovascular disease ; Peptidyl-dipeptidase A ; Toxicity ; Benzimidazole derivatives ; Treatment efficiency ; Controlled therapeutic trial ; Bibliographic review ; Comparative study ; Human ; Chemotherapy ; AT1 angiotensin receptor ; Antagonist ; Angiotensin II ; Angiotensin antagonist ; ACE inhibitor ; Enzyme inhibitor ; Antihypertensive agent ; Telmisartan ; Enalapril ; Hypertension ;

Mots-clés français / French Keywords

Enzyme ; Hydrolases ; Peptidases ; Peptidyl-dipeptidases ; Appareil circulatoire pathologie ; Peptidyl-dipeptidase A ; Toxicité ; Benzimidazole dérivé ; Efficacité traitement ; Essai thérapeutique contrôlé ; Revue bibliographique ; Etude comparative ; Homme ; Chimiothérapie ; Récepteur angiotensine AT1 ; Antagoniste ; Angiotensine II ; Antagoniste angiotensine ; Inhibiteur angiotensin converting enzyme ; Inhibiteur enzyme ; Antihypertenseur ; Telmisartan ; Enalapril ; Hypertension artérielle ;

Mots-clés espagnols / Spanish Keywords

Enzima ; Hydrolases ; Peptidases ; Peptidyl-dipeptidases ; Aparato circulatorio patología ; Peptidyl-dipeptidase A ; Toxicidad ; Benzimidazol derivado ; Eficacia tratamiento ; Ensayo terapéutico controlado ; Revista bibliográfica ; Estudio comparativo ; Hombre ; Quimioterapia ; Receptor angiotensina AT1 ; Antagonista ; Angiotensina II ; Antagonista angiotensina ; Inhibidor angiotensin converting enzyme ; Inhibidor enzima ; Antihipertensivo ; Telmisartán ; Enalapril ; Hipertensión arterial ;

Mots-clés d'auteur / Author Keywords

telmisartan ; enalapril ; hypertension ; angiotensin II-receptor antagonist ; ACE inhibitor ;

Localisation / Location

INIST-CNRS, Cote INIST : 18353, 35400010548635.0010