Practical Efficacy of Telmisartan for Decreasing Morning Home Blood Pressure and Pulse Wave Velocity in Patients with Mild-to-Moderate Hypertension

DOI PubMed 被引用文献14件 参考文献42件
  • UCHIDA Haruhito
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • NAKAMURA Yoshio
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • KAIHARA Masanobu
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • SUGIMOTO Taro
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • NORII Hisanori
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • SASAKI Motofumi
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry
  • SATO Hajime
    Himeji Central Hospital
  • MAKINO Hirofumi
    Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry

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The current guideline-recommended blood pressure values are difficult to maintain in general practice, partly due to the lack of ideal anti-hypertensive agents. Since morning hypertension has a high correlation with cardiovascular events, expectations that telmisartan, a long-acting angiotensin-II type-1 receptor blocker (ARB), can improve cardiovascular mortality are high. In this study, the efficiency of telmisartan in reducing morning hypertension and pulse wave velocity (PWV) as a practical surrogate endpoint was investigated. Seventeen unsupervised and 7 untreated hypertensive patients were prescribed telmisartan 40 mg/day for 3 months. Medication already prescribed upon enrollment in this study was continued, with the exception of ARBs (all of which turned out to be losartan 50 mg/day), which were discontinued and replaced with telmisartan. Morning home blood pressure (MHBP), office blood pressure (OBP), and brachial-ankle PWV (baPWV) were investigated in a prospective fashion. A stratified analysis was performed regarding previous use (group L) or non-use (group N) of losartan. Over a 3-month period, telmisartan was found to significantly reduce both OBP (from 153±13/85±9 to 141±17/80±7 mmHg (p <0.01)) and MHBP (from 153±23/93±11 to 137±22/82±10 mmHg (p <0.001)). Surprisingly, 7 patients (70%) from group L achieved an OBP of less than 140/90 mmHg by simply changing their medication to telmisartan. Furthermore, baPWV fell significantly from 1,892±334 cm/s to 1,672±324 cm/s (p <0.01), which was greater than the change in baPWV estimated by OBP reduction. Here it must be mentioned that there were no significant differences between group L and group N in the courses of blood pressures and baPWV. In conclusion, telmisartan 40 mg/day was found to be effective for reducing MHBP and arterial wall stiffness in patients with mild-to-moderate hypertension, and thus may also be effective for improving cerebrocardiovascular mortality. (Hypertens Res 2004; 27: 545-550)

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