OBJECTIVES: The increasing number of clinical trials in hypertension provides data to inform more effective treatment strategies, but partly generate contradicting results. Synthesis of individual trial data using meta-analytic techniques ensures more reliable estimates on treatment outcomes. To compare the antihypertensive efficacy of telmisartan 40 and 80 mg, against all other available drugs in this class (AIIA) by undertaking a meta-analysis of individual randomised controlled trials. METHODS: Two distinct approaches were followed. Direct comparison of the efficacy of telmisartan versus other AIIA therapies using evidence from studies performed head to head, and indirect comparison using placebo as common comparator. Fixed and random effects meta-analyses were conducted for all comparisons. The studies used reported trough measurements. RESULTS: Direct comparisons of telmisartan 40 mg versus losartan 50 mg on diastolic and systolic blood pressure reduction showed a greater and significant effect for telmisartan. Indirect comparisons showed a greater and significant effect in both trough DBP/SBP versus all other AIIA except candesartan where no significant difference was obtained. In particular, telmisartan 40mg reduced 24-h DBP by 7.3 ± 0.7 compared to: valsartan 80mg 4.7 ± 5.7 (95% CI between tx diff: -4.33, -0.80); irbesartan 150mg 5.2 ± 6.7 (95% CI between tx diff: -4.23, -0,003); losartan 50mg 4.2 ± 5.5 (95%CI between tx diff: -5.09, -1.10); candesartan 8mg 5.8 ± 8.0 (95% CI between tx diff: -3.99, 1.14). Similarly, when comparing higher doses of the drugs, telmisartan 80mg results in greater and significant reductions in both trough DBP and SBP than losartan 100mg and valsartan 160mg, as well as with irbesartan 300mg and candesartan 16mg but with no statistical significance. CONCLUSION: Overall, in the monotherapy studies both low and high dose telmisartan has an advantage in reducing blood pressure over the other drugs of the class.