Comparative study of telmisatran verses olmesatran in essential hypertension patients of Telangana population

 

 

Abstract               Background: 2 groups of patients of essential hypertension HTN (primary hypertension) were treated with telmisatran 40 mg and olmesatran 20 mg per day. From age groups 35 to 75yrs. Method: Total 248 patients having Essential HTN were taken in to the study, they are divided in to 2 groups, group A and group B. The group A (124) were treated with olmesartan 20mg od and group B(124) treated with Telmisartan 40mg od for the period of 12 weeks, and efficiency adverse effects of both drugs were noted. Results: The clinical manifestations of essential Hypertensive patients 62 (25%) had chest pain 38(15.3%) had irregular heart beat 29(11.6%) had severe headache 42(16.9%) had fatigue 12(4.83%) had confusion, 49(19.7%) had difficulty in breathing, 16(6.45%) had vision problems. The comparative effect of both olmesarton 20mg and Telmisartan 40mg, was noted at different intervals of 2nd ,4th ,8th and 12th week and the study had significant P value (P<0.01)in the parameters of SBP and DBP. Conclusion: Telmisartan 40mg was proved to be effective, as it has longer effect of lowing blood pressure with least adverse effects than in comparison olmesarton 20mg.

Key Words: DBP= (Diastolic blood pressure), SPB= (systolic Blood pressure), ARB= (Angiotensin Receptor Blockers). PPAR = (Perioxisome Proliferator- Activated receptor), HTN= Hypertention.

 

 

INTRODUCTION

The Essential HTN (primary hypertension) is high blood pressure above normal levels, that is 120/80 mm/hg .essential hypertension do not have known secondary cases like renal or cardio vascular disease. Increased blood pressure will leads to acute complications like left ventricular failure, ischemic heart disease, cerebral heamarrage. Delayed complications like atherosclerosis, tunica intimal damage with inflammation lacunars infarcts in brain, cerebral hemorrhage, chronic kidney disease, and decreased NO production ^3,4. To control blood pressure certain group of drugs are used they are alfa blockers, beta blockers, calcium channel blockers, angiotensin converting enzyme(ACE) inhibitors, angiotensin receptor blockers (ARB) Among the several ARB available in clinical practice olmesartan have significantly blood pressure lowering effects⁵. On the other hand, with regards to metabolic effect Telmisartan has the unique property of selective Peroxisome prolifarator- activated receptor y (PPARY) modulating activity moreover Telmisartan has blood pressure lowering effect for longer time t 1/2 24 hours ⁶. Hence attempt was made to compare the olmesartan 20mg and Telmisartan 40 mg in different group of essential HTN patients to evaluate the pros and cons so that effective drug can be choice to treat such patients with various clinical symptoms which mimic to be fatal.

 

MATERIAL AND METHODS

248 patients having essential HTN regularly visiting Kamineni Medical College Hospital were selected for study. It is comparative prospective randomized study The age of the patients are between 35 to 75 years,

Inclusive criteria- The patients haveing HTN above 140/90 mm/hg are taken in to the study,and they do not have any secondary causes for HTN. symptoms of high bp like severe headache, fatigue or confusion, vision problems, chest pain, difficulty in breathing, irregular heart beat are included in the study

Method-Total 248 patients are selected for study, they are divided in to two groups group A (124) pts group B( 124 )pts. group A was treated with Telmisatran (40mg) per day and group B was treated with olmesartan (20mg) per day. Routine blood examination, lipid profile to rule out cholesterol levels. urine analsis was done. Blood pressure was recorded with Sphygmomanometer to the left hand in sitting posture. The habits like tobacco chewing, smoking, alcohol consumption, which leads to obesity were noted because these habits aggravate the symptoms of HTN. Both groups (A and B) were given respective tablets for two weeks and asked to come for follow up, after 2 weeks group A,and group pateients BP was recorded and noted at the intervel of 2 weeks for period of 3 months Adverse effects if any were recorded. Total duration of study was about 2 years ( April02014 to october2016

Exclusion criteria: - HTN with DM, kidney diseases, liver diseases, patients with immuno suppressive disease were excluded from study.

Statistical analysis – Clinical manifestations were classified with percentage. The effects of both drugs were compared at different durations and analyzed statistically with 2007 software. The ratio of male and female’s were2:1

 

OBSERVATION AND RESULTS

Table-1 The clinical manifestations of essential Hypertensive patients. chest pain 62 (25%) , irregular heart beat 38(15.3%), severe head ache 29(11.6%) , fatigue 42(16.9%), confusion 12(4.83%) difficulty in breathing 49(19.7%) vision problems 16(6.45%).

 

Table 1: Clinical manifestation in Essential Hypertensive patients (Total No of patients -248)

 

Table-2 comparision of olmisartan and Telmisartan on the parameters of DBP and SBP at certain period. In The study of mean value of base line in DPB 94.05(SD±2.12) in olmisartan , 93.52 (SD±2.60) in Telmisartan, t=1.76 and P value (P>0.96) is insignificant similarly the mean value of SBP was 147.5 (SD±6.2)in olmisarton 147(SD±6.0) in Telmisartan and P value was in significant (P>0.08) In the study of 2^nd week, the mean value of olmisarton in DBP was 84.89(SD±3.31), 85.3(SD±3.59) in Telmisartan t’ test value was 1.15 and P value was highly significant (P<0.01) In study of SBP mean value of olmisartan was 135.6(SD±6.20), 139.6(SD±6.88) Telmisarton ‘t’ test value was 4.80 and P value was highly significant (P<0.01) In the 4^th week, the mean value of DBP in the olmisartan was 83.85(SD±4.6) 85.30(5.37%) Telmisarton ‘t’ test value was 2.28 and P value was highly significant (P<0.01). in SBP mean value of SBP in olmisartan was 134.6(SD±6.27) 139.3 (SD±7.52) Telmisarton ‘t’ test value was 5.34 and P value was highly significant (P<0.01). In the study of 8^th week comparison olmisartan and telmisartan – Mean value of DBP in olmiasrtan was 82.70(SD±6.05) 84.15 (SD±4.60) ‘t’ test value was 2.12 and P value was highly significant (P<0.01). In SBP study mean value of olmistartan 132.3(SD±7.40) 137 (SD±8.20) ‘t’ test value was 4.73 and P value was highly significant (P<0.01). in the 12^th week of the study the mean value of DBP 81.22(SD±5.28) in olmisartan,82.98 (SD±5.90) Telmisarton ‘t’ test value was 2.47 and P value was highly significant (P<0.01). In SBP study the mean value in olmisatran patients 131.3(SD±9.40) 136.1 (SD±6.14) Telmisarton ‘t’ test value was 4.76 and P value was highly significant (P<0.01)

 

 

 

 

Table 2: Comparative study of effects Olmesartan and Telmisartan on the parameters of diastolic and systolic essential HTN patients (Total No of patents 248)

Drug	Parameters	Mean value of Base line	2nd week mean value	4th week mean value	8th week mean value	12th week mean value
Olmisartan	(a)DBP (b)SBP	94.05(SD±2.1) 147.5(SD±6.) P>0.01 insignificant	84.89(SD±3.31) 135.6(SD±6.20) t=1.50, P<0.01(Highly significant)	83.85(SD±4.6) 134.6(SD±6.27) t=2.28 P<0.01(Highly significant)	82.70(SD±5.28) 132.3(SD±7.40) t=2.28 P<0.01(Highly significant)	81.22(SD±5.28) 131.3(SD±9.40) t=2.12 P<0.01(Highly significant)
Telmisartan	(a)DBP (b)SBP	93.52(SD±2.6) 147.7(SD±6.2)   t=4.83P<0.01(Highly significant)	85.3 (SD±3.59) 39.6(SD±6.88) t= 4.80 P<0.01(Highly significant)	85.30(SD±5.37) 139.3(SD±7.52) t=5.34 P<0.01(Highly significant)	84.15(SD±4.60) 139.3(SD±7.52) t=5.34 P<0.01(Highly significant)	82.98(SD±5.90) 136.1(SD±6.14) t=4.73 P<0.01(Highly significant)

DBP= Diastolic blood pressure, SBP= Systolic blood pressure DBP of different week compared in both groups similarly SBP of different weeks compared in both groups and had significant P values (P<0.01)

 

Table-3 The study adverse effects were headache 4(3.22%) observed with olmestartan and dizziness 2(1.6%) observed in Telmisatran

 

Table 3: Study of effects in drugs olmisartan and Telmisartan

 

 

DISCUSSION

In the comparative study of efficacy of olmesartan and telmisartan in essential hypertension. The clinical manifestation in the essential HTN patients-62 (25%) had chest pain 38(15.3%) had irregular heart beat 29(11.6%) had severe headache 42(16.9%) had fatigue 12(4.83%) had confusion, 49(19.7%) had difficulty in breathing, 16(6.45%) had vision problems (Table-1) The comparative study of effects of olmisartan 20mg and Telmisatran 40 mg at different interval of 2^nd, 4^th , 8^th and 12^th week were studied and the parameters of DBP and SBP were highly significant (P<0.01)(Table-2). The adverse effects of headache was 4(3.22%) in olmisartan and 2 (1.61%) in Telmesartan (Table-3) These finding were more or less in agreement with previous studies^7,8. The olmesartan oral dosage from 20-40 mg once daily was effective safe and more officious than losartan 50-100mg daily for HTN and characteristic effect of Telmisartan 40mg in decreasing the diastolic BP(DBP) may be related to longer life ⁹. It was also reported that, there was no significant difference in DBP reduction between olmesartan and Telmisartan group ¹⁰. But olmisartan shows high selectivity and strong binding to AT₁ receptor while Telmisartan has longer t 1/2 on AT₁ receptors, that contributes to a more sustained anti hypertensive effect ¹¹. It was also observed that, Telmisartan 40 mg once daily given results in a significant improvement in glucose metabolism in insulin resistant subjects, with improvement in beta- cell function of pancrease¹². Hence it can be hypothesized that Telmisartan 40 mg orally can be effective to maintain the glucose metabolism in the body. It keeps patients active, sportive without fatigue or pain whole day. Due to proper micro and macro-vascularity around the clock, by reducing Triglyceride and cholesterol level in obese and sedentary patients with essential HTN also.

 

SUMMARY AND CONCLUSION

The present comparative study of therapeutical efficacy of Telmisartan and Olmesartan. The both are equally officious in reducing SBP AND DBP, but due to long acting bloodpressure lowering action of Telmisartan 40 mg per day shows most favorable effects on clinical symptoms essential HTN

 

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