Evaluation of Angiotensin II Receptor Blockers for 24‐Hour Blood Pressure Control: Meta‐Analysis of a Clinical Database

Angiotensin II receptor blockers are well tolerated and improve compliance in hypertensive patients. The need for 24-hour blood pressure control has focused attention on whether all agents in this class maintain smooth antihypertensive effects over a 24-hour period. Insight into this issue emerged from a meta-analysis of five large, multicenter trials in which ambulatory blood pressure monitoring was used to compare the antihypertensive effects of three angiotensin II receptor blockers: telmisartan, losartan, and valsartan. These trials used either a double-blind, placebo-controlled or a prospective, randomized, open-label, blinded-end point design. Initial analysis established the validity of combining ambulatory blood pressure monitoring data from the double-blind, placebo-controlled and prospective, randomized, open-label, blinded-end point designs. Subsequent analyses revealed that telmisartan 80 mg was significantly more effective than losartan 50 mg and valsartan 80 mg for reducing 24-hour mean blood pressure. Furthermore, telmisartan 80 mg was comparable to amlodipine 5 mg for controlling the early morning surge in blood pressure.