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Clinical Question: In patients with isolated systolic
hypertension (ISH), which is effective on the control of urinary albumin
excretion, telmisartan or hydrochlorothiazide?
Bottom Line: In patients with ISH unselected for baseline
albuminuria, telmisartan 20-80 mg after 6 weeks' treatment afforded
significantly greater lowering of UAE than hydrochlorothiazide 12.5 mg,
irrespective of the baseline UAE, and despite comparable reductions in
systolic blood pressure with both drugs.
Reference: The angiotensin II receptor antagonist telmisartan
reduces urinary albumin excretion in patients with isolated systolic
hypertension: results of a randomized, double-blind, placebo-controlled
trial.J Hypertens. 2005 Nov;23(11):2055-2061.Vogt L, Navis G, Koster J,
Manolis AJ, Reid JL, de Zeeuw D; on behalf of the Angiotensin II Receptor
Antagonist Telmisartan Micardis in Isolated Systolic Hypertension (ARAMIS)
Study Group.
Study Design: Randomized, Double-blind, Placebo-controlled
trial
Synopsis: To examine the effect of telmisartan or
hydrochlorothiazide on the control of urinary albumin excretion (UAE) in
patients with isolated systolic hypertension (ISH) unselected for
albuminuria in a pre-planned substudy of a large, multicentre, double-blind,
placebo-controlled, randomized study. The Angiotensin II Receptor Antagonist
Micardis in Isolated Systolic hypertension (ARAMIS) study compared the
antihypertensive efficacy after 6 weeks of once-daily fixed doses of
telmisartan 20, 40 or 80 mg versus hydrochlorothiazide 12.5 mg or placebo in
patients (n = 1039, aged 35-84 years) with ISH (seated blood pressure
150-179/< 90 mmHg). The prospective substudy analysed UAE using spot morning
samples. Urinary albumin (> 2.2-901.6 mg/l) was detected at baseline in 614
out of 918 patients who were included in the substudy analysis. In the
telmisartan group (n = 354, all doses combined), a median reduction in UAE
from a baseline of 14.1% [95% confidence interval (CI) 7.3, 21.8] was
observed versus 1.1% (95% CI -13.5 to 16.0) and 2.7% (95% CI -0.9 to 19.9)
in the hydrochlorothiazide (n = 140) and placebo (n = 120) groups,
respectively. The difference between telmisartan and hydrochlorothiazide was
significant (P = 0.017). Reductions in UAE with telmisartan were observed in
patients with baseline normoalbuminuria, microalbuminuria or
macroalbuminuria. Telmisartan and hydrochlorothiazide produced comparable
reductions in systolic blood pressure in these patients.
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