Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Hypertens Res. 2013 Jul;36(7):627-33. doi: 10.1038/hr.2012.233. Epub 2013 Jan 24.
A previous meta-analysis of six randomized head-to-head trials suggests that the blood pressure (BP)-lowering capabilities of telmisartan may be comparable to those of valsartan. We performed an updated meta-analysis of telmisartan vs. valsartan therapy for the reduction of BP in hypertensive patients. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through August 2012 using web-based search engines (PubMed, OVID). Eligible studies were prospective randomized controlled trials examining telmisartan vs. valsartan therapy and reporting clinic BP as an outcome. For each study, the data regarding changes from baseline to final clinic systolic BP (SBP) and diastolic BP (DBP) in both the telmisartan and valsartan groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Of the 62 potentially relevant articles initially screened, 17 reports about prospective randomized controlled clinical trials of telmisartan vs. valsartan therapy, including a total of 5422 patients with hypertension, were identified and included. Pooled analysis suggested significant differences in BP reductions among the patients randomized to telmisartan vs. valsartan therapy (MD for SBP, -2.04 mm Hg; 95% CI, -2.80 to -1.28 mm Hg; P<0.00001; MD for DBP, -1.08 mm Hg; 95% CI, -1.55 to -0.62 mm Hg; P<0.00001). When data from the monotherapy and combination therapy (with hydrochlorothiazide) trials were pooled separately, telmisartan therapy was associated with a statistically significant difference in BP reductions relative to valsartan therapy in both the monotherapy and combination therapy groups. In conclusion, telmisartan therapy appears to reduce BP more than valsartan therapy in patients with hypertension.
一项先前的荟萃分析包括六项随机头对头试验，结果表明替米沙坦的降压能力可能与缬沙坦相当。我们对替米沙坦与缬沙坦治疗高血压患者血压降低的疗效进行了更新的荟萃分析。通过网络搜索引擎（PubMed、OVID）检索 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，检索时间截至 2012 年 8 月。合格的研究是前瞻性随机对照试验，研究对象为替米沙坦与缬沙坦治疗，并报告诊室血压作为结果。对于每项研究，我们使用基线至最终诊室收缩压（SBP）和舒张压（DBP）的变化数据，生成替米沙坦和缬沙坦组的均值差值（MD）和 95%置信区间（CI）。在最初筛选的 62 篇潜在相关文章中，确定了 17 篇关于替米沙坦与缬沙坦治疗的前瞻性随机对照临床试验报告，共纳入 5422 例高血压患者。汇总分析表明，随机分配至替米沙坦组与缬沙坦组的患者在血压降低方面存在显著差异（SBP 的 MD，-2.04mmHg；95%CI，-2.80 至-1.28mmHg；P<0.00001；DBP 的 MD，-1.08mmHg；95%CI，-1.55 至-0.62mmHg；P<0.00001）。当分别汇总单药治疗和联合治疗（与氢氯噻嗪合用）试验的数据时，替米沙坦治疗与缬沙坦治疗相比，在单药和联合治疗组中均与血压降低有统计学显著差异。总之，替米沙坦治疗似乎比缬沙坦治疗更能降低高血压患者的血压。
