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

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.