Karlberg B E, Lins L E, Hermansson K
Department of Internal Medicine, University Hospital, Linköping, Sweden.
J Hypertens. 1999 Feb;17(2):293-302. doi: 10.1097/00004872-199917020-00015.
To assess the antihypertensive efficacy and safety of the novel AT1 receptor antagonist, telmisartan, compared with that of enalapril in elderly patients with mild to moderate hypertension.
A 26-week, multicenter, double-blind, parallel-group, dosage titration study.
A total of 278 patients aged > or = 65 years were randomized to eithertelmisartan or enalapril once a day. The telmisartan dosage was increased from 20 to 40-80 mg and that of enalapril from 5 to 10-20 mg at 4-week intervals until trough supine diastolic blood pressure was < 90 mmHg. After 12 weeks, hydrochlorothiazide at 12.5-25 mg once a day was added to the treatment regimen of those patients not controlled on monotherapy.
Both treatments lowered blood pressure in a comparable and clinically meaningful manner. The adjusted mean changes from baseline in supine diastolic blood pressure at trough were -12.8 mmHg for telmisartan and -11.4 mmHg for enalapril (P = 0.074). Mean changes in supine systolic blood pressure were -22.1 mmHg for telmisartan and -20.1 mmHg for enalapril (P = 0.350). Overall, 63 and 62% of patients responded to telmisartan and enalapril, respectively, with a supine diastolic blood pressure of < 90 mmHg. Both regimens provided effective blood pressure lowering over the 24 h dosing interval, as determined by ambulatory blood pressure monitoring. Both regimens were well tolerated; however, patients on the enalapril regimen had more than double the incidence of treatment-related cough compared with those on the telmisartan regimen (16 versus 6.5%).
These results demonstrate that telmisartan is well tolerated and is at least as effective as enalapril in treating elderly patients with mild to moderate hypertension.
评估新型AT1受体拮抗剂替米沙坦与依那普利相比，在老年轻至中度高血压患者中的降压疗效及安全性。
一项为期26周的多中心、双盲、平行组、剂量滴定研究。
共278例年龄≥65岁的患者被随机分为每天服用替米沙坦或依那普利。替米沙坦剂量每4周从20mg增至40 - 80mg，依那普利剂量每4周从5mg增至10 - 20mg，直至卧位舒张压谷值<90mmHg。12周后，对单药治疗未控制的患者，在治疗方案中加用每日一次12.5 - 25mg的氢氯噻嗪。
两种治疗均以相似且具有临床意义的方式降低血压。替米沙坦组卧位舒张压谷值较基线的调整后平均变化为-12.8mmHg，依那普利组为-11.4mmHg（P = 0.074）。替米沙坦组卧位收缩压平均变化为-22.1mmHg，依那普利组为-20.1mmHg（P = 0.350）。总体而言，替米沙坦组和依那普利组分别有63%和62%的患者卧位舒张压<90mmHg。动态血压监测显示，两种治疗方案在24小时给药间隔内均能有效降低血压。两种方案耐受性均良好；然而，依那普利治疗组与替米沙坦治疗组相比，治疗相关咳嗽的发生率高出一倍多（16%对6.5%）。
这些结果表明，替米沙坦耐受性良好，在治疗老年轻至中度高血压患者方面至少与依那普利一样有效。
