Telmisartan and a Fixed Combination S-Amlodipine/Atorvastatin in the Treatment of Essential Hypertension: Experience and Prospects for Clinical Use

L.A. Mishchenko, Ye.P. Svishchenko, H.M. Bozhenko

Abstract


The objective of the study is to assess antihypertensive efficacy of telmisartan and its impact on the activity of systemic inflammation and carbohydrate and lipid metabolism in patients with essential hypertension (EH). Materials and methods. The study involved 29 patients with EH stage I–II, degree 1–2, who after a 7-day non-drug period and after 6 months of telmisartan therapy underwent a comprehensive clinical examination, ambulatory blood pressure (BP) monitoring, determination of
C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α), parameters of carbohydrate (glucose, insulin, HOMA, glycated hemoglobin (HbA1C)) and lipid metabolism. Results. Monotherapy with telmisartan made it possible to achieve target BP in 75.6 % of patients; after 6 months of treatment, a decrease in systolic BP was 20 mmHg, in diastolic BP — 13 mmHg. The drug helped to restore the normal two-phase rhythm of BP in patients with its initial disturbances and to reduce variability in systolic BP at night. Discussion. Under the influence of telmisartan, there was an improvement in carbohydrate metabolism manifested by a significant decrease of basal insulinemia by 21.5 %, reduction in glucose levels from 5.5 ± 0.2 mmol/l to 5.3 ± 0.1 mmol/l (p = 0.04) and HbA1c from 5.6 ± 0.1 % to 5.4 ± 0.1 % (p = 0.04). Against the background of telmisartan use, the blood levels of triglycerides have decreased by 17 % (p = 0.03), there was a tendency to lower levels of total cholesterol and low-density lipoprotein cholesterol. It was found that telmisartan treatment reduces serum CRP level by 13.9 % (p = 0.04) and IL-6 by 36.4 % (p = 0.02), but does not affect the content of TNF-α in the blood of patients with EH. Conclusions. The findings indicate a high antihypertensive efficacy and favorable metabolic effects of telmisartan, as well as its ability to inhibit the activity of low-grade inflammation. The article also supports a combined use of telmisartan and a fixed combination S-amlodipine/atorvastatin in terms of improving the prognosis of patients with EH due to the synergy of antihypertensive and lipid-lowering potential and pleiotropic effects of these drugs, whose action is aimed at slowing the progression of EH and atherosclerosis.


Keywords


essential hypertension; blood pressure; telmisartan; S-amlodipine/atorvastatin; systemic inflammation; carbohydrate metabolism; lipid profile.

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DOI: https://doi.org/10.22141/2224-1485.3.47.2016.76368

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