Comparative effectiveness of telmisartan vs. other angiotensin receptor blockers in reducing hypertension-related cerebrovascular and cardiovascular events: a real-world retrospective study using the TriNetX network

TL;DR

This study finds that telmisartan, a type of blood pressure medication, may be more effective than similar drugs in reducing stroke and heart failure risks in older hypertensive patients.

Contribution

The study provides real-world evidence comparing telmisartan to other ARBs, showing its superior effectiveness in reducing cardiovascular and cerebrovascular events.

Findings

Telmisartan was associated with a 19.5% lower risk of stroke compared to other ARBs.

It showed a 25% lower risk of heart failure and a 41% lower risk of all-cause mortality.

Benefits were consistent across subgroups including patients with diabetes and chronic kidney disease.

Abstract

Telmisartan is a long-acting angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including partial PPAR-γ activation. Its comparative effectiveness against other ARBs in real-world populations remains unclear.

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including hypertensive patients aged 55–85 years without prior stroke, heart failure, or myocardial infarction. After 1:1 propensity score matching, 41,598 patients were included in each group.

Telmisartan use was associated with a significantly lower risk of stroke (HR 0.805, 95% CI 0.751–0.863), heart failure (HR 0.75, 95% CI 0.672–0.836), and all-cause mortality (HR 0.59, 95% CI 0.542–0.642) compared to other ARBs. Subgroup analyses showed consistent benefits across sex, diabetes, chronic kidney disease, and hyperlipidemia.

In this large real-world matched cohort of over 83,000 patients, telmisartan was associated with superior cardiovascular and cerebrovascular outcomes compared to other ARBs, supporting its potential as a preferred antihypertensive agent in high-risk populations.

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