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Telmisartan Effectiveness on Left ventricular MAss Reduction (TELMAR) as assessed by magnetic resonance imaging in patients with mild-to-moderate hypertension — a prospective, randomised, double-blind comparison of telmisartan with metoprolol over a period of six months — rationale and study design

Helios-Klinikum Berlin, Franz-Volhard-Klinik, Charité, Humboldt-Universität Berlin, Campus Berlin-Buch, Berlin, Germany, friedrich@ fvk-berlin.de

Björn Dahlöf

Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden

Udo Sechtem

Robert-Bosch-Krankenhaus, Stuttgart, Germany

Thomas Unger

Institut für Pharmakologie und Toxikologie, Charité, Humboldt-Universität Berlin, Campus Mitte, Germany

Mathias Knecht

Boehringer Ingelheim, Ingelheim, Germany

Rainer Dietz

Helios-Klinikum Berlin, Franz-Volhard-Klinik, Charité, Humboldt-Universität Berlin, Campus Berlin-Buch, Berlin, Germany

TELMAR Investigators

The Telmisartan Effectiveness on Left ventricular MAss Reduction (TELMAR) trial will assess the effect of the angiotensin II (Ang II) receptor blocker, telmisartan, on left ventricular hypertrophy (LVH) compared with the β-blocker, metoprolol, at similar antihypertensive doses. The rationale is that antihypertensives reduce LVH, a cardiac adaptation to pressure overload, principally by pressure-related effects. Ang II plays a key role in pressure-independent mechanisms causing LVH, and angiotensin-converting enzyme (ACE) inhibitors induce more pronounced LVH regression than some other antihypertensives. Blocking Ang II Type 1 receptors may be more effective than ACE inhibition in reducing LVH. TELMAR is a prospective, randomised, double-blind, double-dummy, parallel-group trial. A total of 140 patients (age 18—80 years) with uncontrolled essential hypertension (mean daytime systolic blood pressure [SBP] 140 mmHg or diastolic blood pressure [DBP] 90 mmHg and night-time SBP 120 mmHg or DBP 70 mmHg, measured by ambulatory blood pressure monitoring [ABPM]) and left ventricular mass index related to height (LVMI) >0.8 g/cm for females, >1.1 g/cm for males (defined by magnetic resonance imaging [MRI]) will be randomised to once-daily telmisartan or metoprolol. The telmisartan dose will be 40 mg for the first two weeks, 80 mg for 5.5 months and 40 mg for the last two weeks. Metoprolol will be given at a dose of 47.5 mg for two weeks, 95 mg for 5.5 months and 47.5 mg for two weeks. Concomitant add-on medication with hydrochlorothiazide and amlodipine will be allowed. The primary endpoint is the percentage change in LVMI at treatment end versus baseline, using MRI. Secondary variables include blood pressure changes and response rates assessed by ABPM and manual cuff sphygmomanometry, and end-systolic wall stress, systolic left ventricular function (LVF) and diastolic LVF determined by MRI. A separate study was performed prior to the main trial to define the normal range of MRI data in an age-matched population.

Key Words: left ventricular hypertrophy • angiotensin II receptor blocker • telmisartan • β-blocker • metoprolol

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 4, No. 4, 234-243 (2003)
DOI: 10.3317/jraas.2003.038


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Friedrich, M. G Articles by TELMAR Investigators Search for Related Content PubMed PubMed Citation Articles by Friedrich, M. G Articles by TELMAR Investigators, Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Blood Pressure Medicines High Blood Pressure MRI Scans Hazardous Substances DB METOPROLOL Social Bookmarking                         What's this?