Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy

Lacourcière, Yves; Tytus, Richard; O’Keefe, Dennis D.; Lenis, J; Orchard, R T; Martin, K

doi:10.1038/sj.jhh.1001267

Cited by 60 publications

(48 citation statements)

References 25 publications

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“…In several short-term studies, a fixed combination of telmisartan 40 or 80 mg/day in combination with hydrochlorothiazide 12.5 mg was more effective than the single drugs, with the combination of telmisartan 80 mg/hydrochlorothiazide 12.5 mg being the most effective. [50][51][52][53] An ARB-diuretic combination makes a lot of physiologic sense because each drug has a different mechanism of action, each being complementary to the other. Diuretics increase salt and water excretion and cause plasma volume contraction and decrease in blood pressure, resulting in stimulation of renin release and increased production of AII and aldosterone, which cause vasoconstriction, increase in systemic vascular resistance and salt and water retention, leading to increase in blood pressure, thus counter-balancing the hypotensive effect of diuretics.…”

Section: Angiotensin Receptor Blockers Vs Angiotensin-converting Enzymentioning

confidence: 99%

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Chrysant

Desai

2005

J Hum Hypertens

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Poorly controlled hypertension is a major risk for cardiovascular morbidity and mortality, strokes, heart failure and renal failure. Despite these devastating complications, blood pressure control of p140/90 mmHg, which is above the current standard, is very poor worldwide, accounting for 34% of hypertensive patients in the United States, and 6% in other countries. The reasons for this poor control of blood pressure include lack of aggressive treatment by physicians, especially for the systolic blood pressure, drug selection and patient compliance. The blood pressure follows a circadian rhythm and is the highest between 0600 to 1200 h, when most complications occur. Long-acting drugs that extend their action to cover this vulnerable period are preferable, especially those that block the renin-angiotensin-aldosterone system, such as ACE inhibitors and angiotensin receptor blockers, and are the most effective in controlling blood pressure and preventing or reducing its cardiovascular and renal complications. With respect to the angiotensin receptor blockers, telmisartan has been demonstrated by several studies to be the longest acting among its class of drugs and to effectively prevent the early morning rise of blood pressure.

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Section: Angiotensin Receptor Blockers Vs Angiotensin-converting Enzymentioning

confidence: 99%

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Chrysant

Desai

2005

J Hum Hypertens

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“…Obviously, in clinical practice, the most efficient strategy in the presence of a poor response to monotherapy should be not to increase the dose, but to add a diuretic or to shift to another drug, acting through a different mechanism. Accordingly, Lacourcière et al 21 showed that a 'telmisartan 80 mg/HCTZ 12.5 mg fixed dose combination confers significant additional BP reductions compared with continuation of telmisartan monotherapy in nonresponders' (41.5% of patients with normalised BP in the combination treatment group vs 26.1% in telmisartan group; Po0.05), Furthermore, in a recent crossover study by Dickerson et al, 22 a significant correlation was found between the BP responses to angiotensinconverting enzyme inhibitors and betablockers, as well as between those to calcium channel blockers and diuretics, but not between the other four pairing of treatments. Then it could be speculated that patients who fail to respond to renin-angiotensin system blockade should be subsequently given a calcium channel blocker or a diuretic (and conversely).…”

Section: Antihypertensive Effect Of Telmisartan and Of Perindoprilmentioning

confidence: 98%

Comparison of trough effect of telmisartan vs perindopril using self blood pressure measurement: EVERESTE study

et al. 2002

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This multicentre study was aimed at comparing the trough effect of telmisartan and perindopril on diastolic blood pressure (DBP), using self blood pressure measurement (SBPM). A second objective was to compare the data obtained from SBPM with those provided by automatic office BP measurement. A total of 441 mild-to-moderate hypertensive patients were randomised to receive either telmisartan 40 mg or perindopril 4 mg for a period of 12 weeks. Patients whose clinic DBP remained higher than or equal to 90 mmHg at the end of the 6th week (W6) were given a double-dose regimen. Office BP and SBPM were performed at baseline (W0), at W6 and at week 12 (W12), both with the same automatic device. A greater diminution of trough DBP was obtained with telmisartan (À6.6 7 6.7 mmHg) than with perindopril (À5.1 7 7.0 mmHg; P ¼ 0.018). Regarding clinic BP, the same results were observed. Doubling dose was significantly less frequent with telmisartan (41%; n ¼ 85) than with perindopril (55%; n ¼ 115, P ¼ 0.005). Mean values of SBPM were lower than office BP values, with a difference of a greater importance at W0 than at W12: 6.6 vs 4.7 mmHg for systolic blood pressure (Po0.005) and 3.2 vs 1.4 mmHg for DBP (Po0.0001). At W12, isolated office hypertension was found in 9% of the patients (n ¼ 37), while there were 14% of the patients (n ¼ 55) with isolated home hypertension. In conclusion, the trough effect on DBP was statistically higher with telmisartan than with perindopril. SBPM values were lower than office BP values, with greater differences before than after treatment. About a quarter of the patients were found to be controlled with a method but not with the other one.

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“…16 Similarly, hydrochlorothiazide greatly enhances the BP depressor effects of telmisartan. 17,18 Moreover, in mild-to-moderate hypertensive patients who did not respond to telmisartan monotherapy, the addition of low-dose hydrochlorothiazide effectively decreased BP in the first 4 weeks of use. 18 More importantly, the antiproteinuric effects of ACE inhibitors are blunted with salt excess, but the addition of hydrochlorothiazide suppresses the salt-induced increase in urinary protein.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 Moreover, in mild-to-moderate hypertensive patients who did not respond to telmisartan monotherapy, the addition of low-dose hydrochlorothiazide effectively decreased BP in the first 4 weeks of use. 18 More importantly, the antiproteinuric effects of ACE inhibitors are blunted with salt excess, but the addition of hydrochlorothiazide suppresses the salt-induced increase in urinary protein. 19 Moreover, in the GUARD (Gauging Albuminuria Reduction with Lotrel in Diabetic Patients With Hypertension) trial, 20 benazepril plus hydrochlorothiazide showed superior antialbuminuric effects relative to benazepril plus amlodipine.…”

Section: Discussionmentioning

confidence: 99%

Effect of switching from amlodipine to combination therapy with telmisartan and low-dose hydrochlorothiazide

2009

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on behalf of the ONgoing Evaluation of depressor effect And Safety of combination therapy with Telmisartan and low-dose hydrochlorothiazide (ONEAST) Study GroupOne of the most effective pairs in combination therapy is that of an inhibitor of the renin-angiotensin system (RAS) and a lowdose thiazide diuretic. Possible candidates for this combination therapy are hypertensive patients with blood pressure (BP) that is not controlled by a calcium channel blocker (CCB). Thus, we characterized the antihypertensive effect of the combination of telmisartan and low-dose hydrochlorothiazide in patients with hypertension that was not controlled by amlodipine, which is the most common CCB. A total of 75 patients with BP levels higher than 140/90 mm Hg, treated with 5 mg per day of amlodipine for at least 3 months, were divided into groups that were switched to treatment with 40-80 mg per day of telmisartan plus 12.5 mg per day of hydrochlorothiazide (TH, n¼37) or that were continuously treated with 5-7.5 mg per day of amlodipine (Am, n¼38). After 12 weeks of treatment, the mean BP level was significantly lower in the TH group than in the Am group (decrease in BP: À9.9±11.4 vs. À3.7±8.9 mm Hg, Po0.02; normalization rate: 67.6 vs. 30.3%, Po0.01). Serum uric acid was slightly higher in the TH group, but other laboratory data were not different between groups. Therefore, it is suggested that the combination of a RAS inhibitor and a low-dose thiazide is useful if treatment with a CCB cannot control BP in patients with hypertension.

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Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy

Cited by 60 publications

References 25 publications

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Current status of angiotensin receptor blockers for the treatment of cardiovascular diseases: focus on telmisartan

Comparison of trough effect of telmisartan vs perindopril using self blood pressure measurement: EVERESTE study

Effect of switching from amlodipine to combination therapy with telmisartan and low-dose hydrochlorothiazide

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