, Volume 71, Issue 6, pp 651-677
Date: 18 Nov 2012

Telmisartan

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Abstract

Telmisartan (Micardis®, Pritor®), a well established angiotensin type 1 receptor antagonist, is indicated in the EU for the reduction of cardiovascular morbidity in patients with manifest atherothrombotic cardiovascular disease (CVD) or type 2 diabetes mellitus with documented target organ damage, as well as for the treatment of hypertension.

In the pivotal ONTARGET trial, which enrolled ACE inhibitor-tolerant patients at high vascular risk, telmisartan 80 mg once daily added to existing, proven therapy was noninferior to ramipril 10 mg once daily (the gold standard cardioprotective ACE inhibitor) in terms of CVD prevention. Moreover, telmisartan was better tolerated than ramipril, as reflected in, for example, lower incidences of permanent treatment discontinuations due to cough and angioedema. The placebo-controlled TRANSCEND and PRoFESS studies provided supporting evidence for the (time-dependent) effectiveness of telmisartan in preventing cardiovascular events, although the drug appeared to have neither a beneficial nor a harmful impact on cardiovascular mortality. The TRANSCEND trial also demonstrated that telmisartan was well tolerated in ACE inhibitor-intolerant patients at high vascular risk.

On the basis of these findings, telmisartan can be considered an effective treatment option for CVD prevention in patients at high vascular risk. Consideration may be given to prescribing the drug as an alternative to ramipril in patients who are able to tolerate ACE inhibitors and, potentially, instead of ramipril in patients who are unable to tolerate ACE inhibitors.

Various sections of the manuscript reviewed by: M. Burnier, Division of Nephrology and Hypertension Consultation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; M.S. Elisaf, Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece; A. Oguz, Department of Internal Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey; W. Van Mieghem, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; P. Verdecchia, Department of Cardiology, Clinical Research Unit ‘Preventive Cardiology’, Hospital Santa Maria della Misericordia, Perugia, Italy; M. Volpe, Division of Cardiology, Department of Clinical and Molecular Medicine, 2nd Faculty of Medicine, Sapienza University, Rome, Italy.

Data Selection

Sources: Medical literature published in any language since 1980 on ‘telmisartan’, identified using MEDLINE and EMBASE, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.
Search strategy: MEDLINE search terms were ‘telmisartan’ or ‘BIBR-277’ and (‘hypertension’ or ‘hypertensive’). EMBASE search terms were ‘telmisartan’ and (‘hypertension’ or ‘hypertensive’). AdisBase search terms were ‘telmisartan’ or BIBR-277’ and (‘hypertension’ or ‘hypertensive’). Searches were last updated 5 March 2011.
Selection: Studies in patients with manifest atherothrombotic cardiovascular disease or type 2 diabetes mellitus who received telmisartan. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.
Index terms: Telmisartan, angiotension type 1 receptor antagonist, cardiovascular disease prevention, cardiovascular morbidity and mortality, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.