Comparison of the efficacy and tolerability of telmisartan and enalapril in patients of mild to moderate essential hypertension.

Sir,

I have read the article “Comparison of the efficacy and tolerability of telmisartan and enalapril in patients of mild to moderate essential hypertension” by Pramod et al[1]. published in Indian Journal Pharmacology with great interest. The methodology of the study has the following flaws which I would wish to state:

The total number of the patients in the present study is 80 and each group contains 40 patients. But, the authors have not mentioned how they calculated the sample size and what is the power in the present study. In a clinical study, the sample size should be adequate enough to establish the effect of a particular treatment. Usually, the power of a clinical study should be 80 to 90%. The sample size of the present study does not seem adequate.

Patients with mild to moderate essential hypertension were included in the study, but the authors have not defined mild to moderate essential hypertension (i.e., the ranges of systolic and diastolic blood pressure [BP]) even once in the methodology section.

A study flow diagram of the clinical trial is usually mentioned. This tells the reader about the number of patients who were screened, randomized, and who actually completed the study. Nothing is mentioned regarding these in the result.

It is not very clear why the primary end point was the change from baseline sitting diastolic BP and not systolic BP. However, there is strong evidence that systolic BP is a better predictor of cardiovascular events.