24-hour powerful blood pressure-lowering: is there a clinical need?

Attenuation of 24-hour blood pressure (BP) fluctuation, and control of the early morning BP surge, may help to improve cardiovascular outcomes in hypertensive patients. However, studies show that early morning BP is generally poorly controlled even in patients with well-controlled clinic BP. Few antihypertensives are sufficiently long-acting to sustain adequate BP-lowering for the full 24 hours between once-daily doses, and indeed many are at their lowest efficacy during the risky early morning period. The angiotensin receptor blocker (ARB) telmisartan has the longest plasma half-life, highest lipophilicity, highest receptor binding affinity, and slowest dissociation of any ARB, making it particularly suitable for sustained 24-hour BP control. In clinical studies, telmisartan provides 24-hour BP control superior to that of the ARBs losartan and valsartan, the calcium-channel blocker amlodipine, and the angiotensin-converting enzyme (ACE) inhibitor ramipril. This agent is particularly effective during the last 6 hours of the dosing interval when the other antihypertensives tend to go down in effectiveness. Telmisartan is, therefore, a highly appropriate antihypertensive for sustained 24-hour BP control, especially during the risky early morning hours.