Telmisartan Plus HCTZ vs. Amlodipine Plus HCTZ in Older Patients With Systolic Hypertension: Results From a Large Ambulatory Blood Pressure Monitoring Study


Steen Neldam, MD, Rodøvre Centrum 294, 2610 Rodøvre, Denmark


Systolic hypertension often requires combination therapy. Few data exist comparing angiotensin receptor blocker plus diuretic therapy with other combinations in older patients. In a prospective, randomized, open-label, blinded-end point trial, patients (≥60 years of age) with predominantly systolic hypertension received telmisartan 40–80 mg or amlodipine 5–10 mg for 8 weeks, before the addition of hydrochlorothiazide (HCTZ) 12.5 mg for a further 6 weeks. Twenty-four-hour ambulatory blood pressure monitoring showed that telmisartan plus HCTZ (n =448) and amlodipine plus HCTZ (n =424) changed systolic blood pressure for the last 6 hours of the dosing interval by −18.3 and −17.4 mm Hg, respectively (p =0.2520). Over the 24-hour period, telmisartan plus HCTZ was superior (−19.3 and −17.2 mm Hg, respectively; p =0.001) and provided higher systolic control rates (65.9% and 58.3%, respectively; p =0.0175). Adverse events (41.2% and 53.7%, respectively) and discontinuations (5.0% and 11.3%, respectively) were lower (p<0.0001) with telmisartan than with amlodipine, mainly due to peripheral edema (1.2% and 24.3%, respectively).