Which is the preferred angiotensin II receptor blocker-based combination therapy for blood pressure control in hypertensive patients with diabetic and non-diabetic renal impairment? Full Text
Cardiovascular Diabetology,

Mallat SG – Clinical studies suggest that in CV high–risk patients and those with evidence of renal disease, the use of an ARB/CCB combination may be preferred to ARB/HCTZ combinations due to superior renoprotective and CV benefits and reduced metabolic side effects in patients with concomitant metabolic disorders. However, selection of the most appropriate antihypertensive combination should be dependent on careful review of the individual patient and appropriate consideration of drug pharmacology.

  • Hypertension is a major associated risk for organ damage and mortality, which is further heightened in patients with prior cardiovascular (CV) events, comorbid diabetes mellitus, microalbuminuria and renal impairment.
  • Given that most patients with hypertension require at least two antihypertensives to achieve blood pressure (BP) goals, identifying the most appropriate combination regimen based on individual risk factors and comorbidities is important for risk management.
  • Single–pill combinations (SPCs) containing two or more antihypertensive agents with complementary mechanisms of action offer potential advantages over free–drug combinations, including simplification of treatment regimens, convenience and reduced costs.
  • The improved adherence and convenience resulting from SPC use is recognised in updated hypertension guidelines.
  • Despite a wide choice of SPCs for hypertension treatment, clinical evidence from direct head–to–head comparisons to guide selection for individual patients is lacking.
  • However, in patients with evidence of renal disease or at greater risk of developing renal disease, such as those with diabetes mellitus, microalbuminuria and high–normal BP or overt hypertension, guidelines recommend renin–angiotensin system (RAS) blocker–based combination therapy due to superior renoprotective effects compared with other antihypertensive classes.
  • Furthermore, RAS inhibitors attenuate the oedema and renal hyperfiltration associated with calcium channel blocker (CCB) monotherapy, making them a good choice for combination therapy.
  • The occurrence of angiotensin–converting enzyme (ACE) inhibitor–induced cough supports the use of angiotensin II receptor blockers (ARBs) for RAS blockade rather than ACE inhibitors.
  • In this regard, ARB–based SPCs are available in combination with the diuretic, hydrochlorothiazide (HCTZ) or the calcium CCB, amlodipine.
  • Telmisartan, a long–acting ARB with preferential pharmacodynamic profile compared with several other ARBs, and the only ARB with an indication for the prevention of CV disease progression, is available in two SPC formulations, telmisartan/HCTZ and telmisartan/amlodipine.

Please login or register to follow this author.
► Click here to access Full Text, PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Endocrinology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Endocrinology Articles

1 Effects of 12 weeks high-dose vitamin D3 treatment on insulin sensitivity, beta cell function, and metabolic markers in patients with type 2 diabetes and vitamin D insufficiency – A double-blind, randomized, placebo-controlled trial Metabolism, July 9, 2014    Clinical Article

2 Are sulfonylurea and insulin therapies associated with a larger risk of cancer than metformin therapy? A retrospective database analysis Diabetes Care, October 24, 2014    Clinical Article

3 Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008: little short-term influence of sunshine hours or average temperature Pediatric Diabetes, October 16, 2014    Clinical Article

4 Efficacy and safety of mirogabalin (DS-5565) for the treatment of diabetic peripheral neuropathic pain: a randomized, double-blind, placebo- and active comparator–controlled, adaptive proof-of-concept phase 2 study Diabetes Care, September 19, 2014    Clinical Article

5 Hemoglobin A1c less than 6.5% on admission increases risk for in-hospital and 1-year mortality in patients with diabetes and chest pain Cardiovascular Endocrinology, September 2, 2014    Clinical Article

6 Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the action to control cardiovascular risk in diabetes study) The American Journal of Cardiology, October 3, 2014    Clinical Article

7 New insulin glargine 300 units/ml versus glargine 100 units/ml in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2) Diabetes Care, September 22, 2014    Clinical Article

8 The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012 European Heart Journal: Acute Cardiovascular Care, October 1, 2014    Clinical Article

9 Latent autoimmune diabetes in adults with low-titer GAD antibodies: Similar disease progression with type 2 diabetes: A nationwide, multicenter prospective study (LADA China Study 3) Diabetes Care, October 24, 2014    Clinical Article

10 Metformin powder formulation compared to metformin tablets on glycemic control and on treatment satisfaction in subjects with type 2 diabetes mellitus The Journal of Clinical Pharmacology, October 20, 2014    Clinical Article

11 Effects of 12 weeks treatment with fermented milk on blood pressure, glucose metabolism and markers of cardiovascular risk in patients with type 2 diabetes: a randomised double-blind placebo-controlled study European Journal of Endocrinology, October 13, 2014    Clinical Article

12 Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin Acta Diabetologica, October 15, 2014    Clinical Article

13 Liraglutide and the preservation of pancreatic β-cell function in early type 2 diabetes: The LIBRA Trial Diabetes Care, September 26, 2014    Clinical Article

14 Initial combination of linagliptin and metformin compared with linagliptin monotherapy in newly diagnosed type 2 diabetes patients with marked hyperglycaemia: a randomised, double-blind, active-controlled, parallel group, multinational clinical trial Diabetes, Obesity and Metabolism, October 10, 2014    Clinical Article

15 New insulin glargine 300 U/mL versus glargine 100 U/mL in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2) Diabetes Care, September 12, 2014    Clinical Article

16 The pharmacokinetics of metformin and concentrations of HbA1C and lactate in Indigenous and non-Indigenous Australians with type 2 diabetes mellitus British Journal of Clinical Pharmacology, October 9, 2014    Clinical Article

17 An early pregnancy HbA1c ≥5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes Diabetes Care, September 12, 2014    Clinical Article

18 New insulin glargine 300 units/ml versus glargine 100 units/ml in people with type 2 diabetes using oral agents and basal insulin: Glucose control and hypoglycemia in a 6-month randomized controlled trial (EDITION 2) Diabetes Care, October 23, 2014    Clinical Article

19 The effect of proton pump inhibitors on glycated hemoglobin levels in patients with type 2 diabetes mellitus Canadian Journal of Diabetes, October 28, 2014    Review Article

20 Effect of canagliflozin on blood pressure and adverse events related to osmotic diuresis and reduced intravascular volume in patients with type 2 diabetes mellitus The Journal of Clinical Hypertension, October 24, 2014    Clinical Article

Indexed Journals in Endocrinology: Endocrinology, Journal of Endocrinology, Clinical Endocrinology, Diabetesmore