ObjectiveTo assess the antihypertensive efficacy and safety of the novel AT1receptor antagonist, telmisartan, compared with that of enalapril in elderly patients with mild to moderate hypertension.DesignA 26–week, multicenter, double-blind, parallel-group, dosage titration study.MethodsA total of 278 patients aged ≥ 65 years were randomized to either telmisartan or enalapril once a day. The telmisartan dosage was increased from 20 to 40–80 mg and that of enalapril from 5 to 10–20 mg at 4–week intervals until trough supine diastolic blood pressure was < 90 mmHg. After 12 weeks, hydrochlorothiazide at 12.5–25 mg once a day was added to the treatment regimen of those patients not controlled on monotherapy.ResultsBoth treatments lowered blood pressure in a comparable and clinically meaningful manner. The adjusted mean changes from baseline in supine diastolic blood pressure at trough were −12.8 mmHg for telmisartan and −11.4 mmHg for enalapril (P= 0.074). Mean changes in supine systolic blood pressure were −22.1 mmHg for telmisartan and −20.1 mmHg for enalapril (P= 0.350). Overall, 63 and 62% of patients responded to telmisartan and enalapril, respectively, with a supine diastolic blood pressure of < 90 mmHg. Both regimens provided effective blood pressure lowering over the 24 h dosing interval, as determined by ambulatory blood pressure monitoring. Both regimens were well tolerated; however, patients on the enalapril regimen had more than double the incidence of treatment-related cough compared with those on the telmisartan regimen (16 versus 6.5%).ConclusionsThese results demonstrate that telmisartan is well tolerated and is at least as effective as enalapril in treating elderly patients with mild to moderate hypertension.