Effect of switching from amlodipine to combination therapy with telmisartan and low-dose hydrochlorothiazide.
One of the most effective pairs in combination therapy is that of an inhibitor of the renin-angiotensin system (RAS) and a low-dose 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, n=37) or that were continuously treated with 5-7.5 mg per day of amlodipine (Am, n=38). After 12 weeks of treatment, the mean BP level was significantly lower in the TH group than in the Am group (decrease in BP: -9.9+/-11.4 vs. -3.7+/-8.9 mm Hg, P<0.02; normalization rate: 67.6 vs. 30.3%, P<0.01). 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.
Ando
Katsuyuki
K
Division of Molecular Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan. katsua-tky@umin.ac.jp
Isshiki
Masashi
M
Takahashi
Katsutoshi
K
D000368:Aged; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D001565:Benzoates / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000077333:Telmisartan; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D002121:Calcium Channel Blockers; D004232:Diuretics; D006852:Hydrochlorothiazide; D017311:Amlodipine; D014527:Uric Acid; D000077333:Telmisartan