Telmisartan and hydrochlorothiazide combination therapy for the treatment of hypertension Reprinted with permission (via Copyright Clearance Center) from Current Medical Research & Opinion, Vol. 26, No 4, 2010, 879-887. Copyright 2010 Informa UK doi: 10.1185/03007991003635178
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Published:
Dec 31, 2011
Keywords:
Angiotensin receptor antagonists, Blood pressure, Cardiovascular events, Hydrochlorothiazide, Telmisartan, Thiazide diuretics
Main Article Content
Abstract
Background: Control of elevated blood pressure has been shown to reduce the risk of cardiovascular events. The angiotensin II receptor blocker (ARB), telmisartan, has been shown to provide effective 24- hour blood pressure control. Additional antihypertensive efficacy can be achieved by combining telmisartan with the thiazide diuretic hydrochlorothiazide (HCTZ).
Objective: To review the clinical data in combination therapy with telmisartan and HCTZ.
Methods: Search of Medline and Embase for published clinical studies using the keywords telmisartan and HCTZ.
Findings: The telmisartan/HCTZ combination provides significant reductions in blood pressure, effective 24-hour blood pressure control and is well-tolerated. Blood pressure reductions with this combination are greater than those achieved with either drug alone, and in comparative studies telmisartan/HCTZ is more effective than other ARB/HCTZ combinations. However, it should be noted that some of the combinations assessed used doses of the drugs that were commercially available at the time of the trial and not higher doses that have been shown to have greater antihypertensive efficacy.
Conclusion: The combination of telmisartan/HCTZ is an effective and well-tolerated treatment option for patients with hypertension.
Article Details
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Kjeldsen , S., Schmieder , R., Unger , T., & Mancia , G. (2011). Telmisartan and hydrochlorothiazide combination therapy for the treatment of hypertension. Medycyna Faktow (J EBM), 4(4(13), 73-85. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2507
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References
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10. Mancia G.: Role of outcome trials in providing information on antihypertensive treatment: importance and limitations. Am. J. Hypertens. 2006; 19: 1-7.
11. Ong K.L., Cheung B.M., Man Y.B. et al.: Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 2007; 49: 69-75.
12. MacDonald T.M., Morant S.V., Mozaffari E.: Drug treatment discontinuation and achievement of target blood pressure and cholesterol in United Kingdom primary care. Curr. Med. Res. Opin. 2007; 23: 2765-74.
13. Hansson L., Zanchetti A., Carruthers S.G. et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755-62.
14. Campbell N.R., McAlister F.A., Duong-Hua M. et al.: Polytherapy with two or more antihypertensive drugs to lower blood pressure in elderly Ontarians. Room for improvement. Can. J. Cardiol. 2007; 23: 783-7.
15. Bangalore S., Kamalakkannan G., Parkar S. et al.: Fixed-dose combinations improve medication compliance: a meta-analysis. Am. J. Med. 2007; 120: 713-19.
16. Jackson K.C., Sheng X., Nelson R.E. et al.: Adherence with multiple-combination antihypertensive pharmacotherapies in a US managed care database. Clin. Ther. 2008; 30: 1558-63.
17. The ONTARGET® Investigators: Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 2008; 358: 1547-59.
18. McGill J.B., Reilly P.A.: Telmisartan plus hydrochlorothiazide versus telmisartan or hydrochlorothiazide monotherapy in patients with mild to moderate hypertension: a multicenter, randomized, double-blind, placebo-controlled, parallel- group trial. Clin. Ther. 2001; 23: 833-50.
19. Neutel J.M., Littlejohn T.W., Chrysant S.G. et al.: Telmisartan/hydrochlorothiazide in comparison with osartan/hydrochlorothiazide in managing patients with mild-to-moderate hypertension. Hypertens. Res. 2005; 28: 555-63.
20. Lacourcière Y., Gil-Extremera B., Mueller O. et al.: Efficacy and tolerability of fixed-dose combinations of telmisartan plus HCTZ compared with losartan plus HCTZ in patients with essential hypertension. Int. J. Clin. Pract. 2003; 57: 273-9.
21. Lacourcière Y., Neutel J.M., Schumacher H.: Comparison of fixed-dose combinations of telmisartan/hydrochlorothiazide 40/12.5 mg and 80/12.5 mg and a fixed dose combination of losartan/hydrochlorothiazide 50/12.5 mg in mild to moderate essential hypertension: pooled analysis of two multicenter, prospective, randomized, open-label, blinded-end point (PROBE) trials. Clin. Ther. 2005; 27: 1795-805.
22. Fogari R., Zoppi A., Mugellini A. et al.: Effectiveness of hydrochlorothiazide in combination with telmisartan and olmesartan in adults with moderate hypertension not controlled with monotherapy: a prospective, randomized, openlabel, blinded end point (PROBE), parallel-arm study. Curr. Ther. Res. 2008; 69: 1-15.
23. White W.B., Punzi H.A., Murwin D. et al.: Effects of the angiotensin II receptor blockers telmisartan vs valsartan in combination with hydrochlorothiazide 25 mg once daily for the treatment of hypertension. J. Clin. Hypertens. 2006; 8: 626-33.
24. White W.B., Murwin D., Chrysant S.G. et al.: Effects of the angiotensin II receptor blockers telmisartan vs valsartan in combination with hydrochlorothiazide: a large, confirmatory trial. Blood Press Monit. 2008; 13: 21-7.
25. Venkata C., Ram S.: Antihypertensive efficacy of angiotensin receptor blockers in combination with hydrochlorothiazide: a review of the factorial- design studies. J. Clin. Hypertens. 2004; 6: 569-77.
26. Fogari R., Mugellini A., Zoppi A. et al.: Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J. Hum. Hypertens. 2006; 20: 177-85.
27. Lacourcière Y., Tytus R., O’Keefe D. et al.: Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy. J. Hum. Hypertens. 2001; 15: 763-70.
28. Lacourcière Y., Martin K.: Comparison of a fixed-dose combination of 40 mg telmisartan plus 12.5 mg hydrochlorothiazide with 40 mg telmisartan in the control of mild to moderate hypertension. Am. J. Ther. 2002; 9: 111-17.
29. Neldam S., Edwards C.: Results of increasing doses of hydrochlorothiazide in combination with an angiotensin receptor blocker in patients with uncontrolled hypertension. J. Clin. Hypertens. 2008; 10: 612-18.
30. Neldam S., Edwards C.: Long-term, open-label evaluation of the safety and efficacy of telmisartan 80 mg/hydrochlorothiazide 25 mg fixeddose combination alone or with other antihypertensive medication. Expert Opin. Pharmacother. 2009; 10: 345-52.
31. Karlberg B.E., Lins L.E., Hermansson K.: Efficacy and safety of telmisartan, a selective AT1 receptor antagonist, compared with enalapril in elderly patients with primary hypertension. TEES Study Group. J. Hypertens. 1999; 17: 293-302.
32. Fenton C., Keating G.M., Scott L.J.: Telmisartan/hydrochlorothiazide in the treatment of essential hypertension. Drugs 2003; 63: 2013-26.
33. Neldam S., Edwards C.: Telmisartan plus HCTZ vs. amlodipine plus HCTZ in older patients with systolic hypertension: results from a large ambulatory blood pressure monitoring study. Am. J. Geriatr. Cardiol. 2006; 15: 151-60.
34. Sharma A.M., Davidson J., Koval S. et al.: Telmisartan/hydrochlorothiazide versus valsartan/hydrochlorothiazide in obese hypertensive patients with type 2 diabetes: the SMOOTH® study. Cardiovasc. Diabetol. 2007; 6: 28.
35. Hall W.D.: Pathophysiology of hypertension in blacks. Am J Hypertens 1990; 3:366-71S
36. Preston RA, Materson BJ, Reda DJ, et al. Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. JAMA 1998; 280: 1168-72.
37. Mallion J.M., Goldberg A.I.: Global efficacy and tolerability of losartan, an angiotensin II subtype 1-receptor antagonist, in the treatment of hypertension. Blood Press 1996; 5(supl. 2): 82-6.
38. Goldberg A., Sweet C.: Efficacy and safety of losartan. Can. J. Cardiol. 1995; 11(supl. F): 27-32F.
39. McGill J.B., Reilly P.A.: Combination treatment with telmisartan and hydrochlorothiazide in black patients with mild to moderate hypertension. Clin. Cardiol. 2001; 24: 66-72.
40. White D.B., Weber M.A., Davidai G. et al.: Ambulatory blood pressure monitoring in the primary care setting: assessment of therapy on the circadian variation of blood pressure from the MICCAT-2 trial. Blood Press Monit. 2005; 10: 157-63.
41. Schumacher H., Mancia G.: The safety profile of telmisartan as monotherapy or combined with hydrochlorothiazide: a retrospective analysis of 50 studies. Blood Press 2008; 17(supl. 1): 32-40.
42. Beermann B., Groschinsky-Grind M.: Pharmacokinetics of hydrochlorothiazide in man. Eur. J. Clin. Pharmacol. 1977; 12: 297-303.
43. Siscovick D.S., Raghunathan T.E., Psaty B.M. et al.: Diuretic therapy for hypertension and the risk of primary cardiac arrest. N. Engl. J. Med. 1994; 330: 1852-7.
44. Neutel J., Smith D., Weber M.A.: Low-dose combination therapy: an important first-line treatment in the management of hypertension. Am. J. Hypertens. 2001; 14: 286-92.
45. Moser M., Black H.: The role of combination therapy in the treatment of hypertension. Am. J. Hypertens. 1998; 11: 73-8S.
2. Collins R., Peto R., MacMahon S. et al.: Blood pressure, stroke, and coronary heart disease. Lancet 1990; 335: 827-38.
3. MacMahon S., Rodgers A.: Blood pressure, antihypertensive treatment and stroke risk. J. Hypertens. Suppl. 1994; 12: S5-14.
4. Turnbull F.: Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362: 1527-35.
5. Staessen J.A., Wang J.G., Thijs L.: Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J. Hypertens. 2003; 21: 1055-76.
6. Turnbull F., Neal B., Pfeffer M. et al.: Blood pressure-dependent and independent effects of agents that inhibit the renin angiotensin system. J. Hypertens. 2007; 25: 951-8.
7. Chobanian A.V., Bakris G.L., Black H.R. et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, and Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560-72.
8. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the management of arterial hypertension. J. Hypertens. 2007; 25: 1105-87.
9. Messerli F.H., Mancia G., Conti C.R. et al.: Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann. Intern. Med. 2006; 144: 884-93.
10. Mancia G.: Role of outcome trials in providing information on antihypertensive treatment: importance and limitations. Am. J. Hypertens. 2006; 19: 1-7.
11. Ong K.L., Cheung B.M., Man Y.B. et al.: Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension 2007; 49: 69-75.
12. MacDonald T.M., Morant S.V., Mozaffari E.: Drug treatment discontinuation and achievement of target blood pressure and cholesterol in United Kingdom primary care. Curr. Med. Res. Opin. 2007; 23: 2765-74.
13. Hansson L., Zanchetti A., Carruthers S.G. et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755-62.
14. Campbell N.R., McAlister F.A., Duong-Hua M. et al.: Polytherapy with two or more antihypertensive drugs to lower blood pressure in elderly Ontarians. Room for improvement. Can. J. Cardiol. 2007; 23: 783-7.
15. Bangalore S., Kamalakkannan G., Parkar S. et al.: Fixed-dose combinations improve medication compliance: a meta-analysis. Am. J. Med. 2007; 120: 713-19.
16. Jackson K.C., Sheng X., Nelson R.E. et al.: Adherence with multiple-combination antihypertensive pharmacotherapies in a US managed care database. Clin. Ther. 2008; 30: 1558-63.
17. The ONTARGET® Investigators: Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 2008; 358: 1547-59.
18. McGill J.B., Reilly P.A.: Telmisartan plus hydrochlorothiazide versus telmisartan or hydrochlorothiazide monotherapy in patients with mild to moderate hypertension: a multicenter, randomized, double-blind, placebo-controlled, parallel- group trial. Clin. Ther. 2001; 23: 833-50.
19. Neutel J.M., Littlejohn T.W., Chrysant S.G. et al.: Telmisartan/hydrochlorothiazide in comparison with osartan/hydrochlorothiazide in managing patients with mild-to-moderate hypertension. Hypertens. Res. 2005; 28: 555-63.
20. Lacourcière Y., Gil-Extremera B., Mueller O. et al.: Efficacy and tolerability of fixed-dose combinations of telmisartan plus HCTZ compared with losartan plus HCTZ in patients with essential hypertension. Int. J. Clin. Pract. 2003; 57: 273-9.
21. Lacourcière Y., Neutel J.M., Schumacher H.: Comparison of fixed-dose combinations of telmisartan/hydrochlorothiazide 40/12.5 mg and 80/12.5 mg and a fixed dose combination of losartan/hydrochlorothiazide 50/12.5 mg in mild to moderate essential hypertension: pooled analysis of two multicenter, prospective, randomized, open-label, blinded-end point (PROBE) trials. Clin. Ther. 2005; 27: 1795-805.
22. Fogari R., Zoppi A., Mugellini A. et al.: Effectiveness of hydrochlorothiazide in combination with telmisartan and olmesartan in adults with moderate hypertension not controlled with monotherapy: a prospective, randomized, openlabel, blinded end point (PROBE), parallel-arm study. Curr. Ther. Res. 2008; 69: 1-15.
23. White W.B., Punzi H.A., Murwin D. et al.: Effects of the angiotensin II receptor blockers telmisartan vs valsartan in combination with hydrochlorothiazide 25 mg once daily for the treatment of hypertension. J. Clin. Hypertens. 2006; 8: 626-33.
24. White W.B., Murwin D., Chrysant S.G. et al.: Effects of the angiotensin II receptor blockers telmisartan vs valsartan in combination with hydrochlorothiazide: a large, confirmatory trial. Blood Press Monit. 2008; 13: 21-7.
25. Venkata C., Ram S.: Antihypertensive efficacy of angiotensin receptor blockers in combination with hydrochlorothiazide: a review of the factorial- design studies. J. Clin. Hypertens. 2004; 6: 569-77.
26. Fogari R., Mugellini A., Zoppi A. et al.: Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J. Hum. Hypertens. 2006; 20: 177-85.
27. Lacourcière Y., Tytus R., O’Keefe D. et al.: Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy. J. Hum. Hypertens. 2001; 15: 763-70.
28. Lacourcière Y., Martin K.: Comparison of a fixed-dose combination of 40 mg telmisartan plus 12.5 mg hydrochlorothiazide with 40 mg telmisartan in the control of mild to moderate hypertension. Am. J. Ther. 2002; 9: 111-17.
29. Neldam S., Edwards C.: Results of increasing doses of hydrochlorothiazide in combination with an angiotensin receptor blocker in patients with uncontrolled hypertension. J. Clin. Hypertens. 2008; 10: 612-18.
30. Neldam S., Edwards C.: Long-term, open-label evaluation of the safety and efficacy of telmisartan 80 mg/hydrochlorothiazide 25 mg fixeddose combination alone or with other antihypertensive medication. Expert Opin. Pharmacother. 2009; 10: 345-52.
31. Karlberg B.E., Lins L.E., Hermansson K.: Efficacy and safety of telmisartan, a selective AT1 receptor antagonist, compared with enalapril in elderly patients with primary hypertension. TEES Study Group. J. Hypertens. 1999; 17: 293-302.
32. Fenton C., Keating G.M., Scott L.J.: Telmisartan/hydrochlorothiazide in the treatment of essential hypertension. Drugs 2003; 63: 2013-26.
33. Neldam S., Edwards C.: Telmisartan plus HCTZ vs. amlodipine plus HCTZ in older patients with systolic hypertension: results from a large ambulatory blood pressure monitoring study. Am. J. Geriatr. Cardiol. 2006; 15: 151-60.
34. Sharma A.M., Davidson J., Koval S. et al.: Telmisartan/hydrochlorothiazide versus valsartan/hydrochlorothiazide in obese hypertensive patients with type 2 diabetes: the SMOOTH® study. Cardiovasc. Diabetol. 2007; 6: 28.
35. Hall W.D.: Pathophysiology of hypertension in blacks. Am J Hypertens 1990; 3:366-71S
36. Preston RA, Materson BJ, Reda DJ, et al. Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. JAMA 1998; 280: 1168-72.
37. Mallion J.M., Goldberg A.I.: Global efficacy and tolerability of losartan, an angiotensin II subtype 1-receptor antagonist, in the treatment of hypertension. Blood Press 1996; 5(supl. 2): 82-6.
38. Goldberg A., Sweet C.: Efficacy and safety of losartan. Can. J. Cardiol. 1995; 11(supl. F): 27-32F.
39. McGill J.B., Reilly P.A.: Combination treatment with telmisartan and hydrochlorothiazide in black patients with mild to moderate hypertension. Clin. Cardiol. 2001; 24: 66-72.
40. White D.B., Weber M.A., Davidai G. et al.: Ambulatory blood pressure monitoring in the primary care setting: assessment of therapy on the circadian variation of blood pressure from the MICCAT-2 trial. Blood Press Monit. 2005; 10: 157-63.
41. Schumacher H., Mancia G.: The safety profile of telmisartan as monotherapy or combined with hydrochlorothiazide: a retrospective analysis of 50 studies. Blood Press 2008; 17(supl. 1): 32-40.
42. Beermann B., Groschinsky-Grind M.: Pharmacokinetics of hydrochlorothiazide in man. Eur. J. Clin. Pharmacol. 1977; 12: 297-303.
43. Siscovick D.S., Raghunathan T.E., Psaty B.M. et al.: Diuretic therapy for hypertension and the risk of primary cardiac arrest. N. Engl. J. Med. 1994; 330: 1852-7.
44. Neutel J., Smith D., Weber M.A.: Low-dose combination therapy: an important first-line treatment in the management of hypertension. Am. J. Hypertens. 2001; 14: 286-92.
45. Moser M., Black H.: The role of combination therapy in the treatment of hypertension. Am. J. Hypertens. 1998; 11: 73-8S.