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 Family Medicine

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

<

Most Popular Family Medicine Articles

1 Controlling obesity with potato extract McGill University News, December 11, 2014

2 Calcium and phosphorus intake and prostate cancer risk: A 24-y follow-up study American Journal of Clinical Nutrition, November 26, 2014    Clinical Article

3 Boiled coffee consumption and the risk of prostate cancer: follow-up of 224,234 Norwegian men 20-69 years British Journal of Cancer, December 24, 2014    Clinical Article

4 The use of aspirin and the risk of mortality in patients with prostate cancer The Journal of Urology, December 8, 2014    Clinical Article

5 Influence of metformin use on PSA values, free-to-total PSA, prostate cancer incidence and grade and overall survival in a prospective screening trial (ERSPC Aarau) World Journal of Urology, November 3, 2014    Clinical Article

6 Tea consumption and leukemia risk: A meta-analysis Tumor Biology, February 12, 2014    Evidence Based Medicine    Clinical Article

7 Tai chi as an alternative and complimentary therapy for anxiety: A systematic review Journal of Evidence-Based Complementary & Alternative Medicine, December 22, 2014    Evidence Based Medicine    Review Article

8 Dairy products, calcium, and prostate cancer risk: A systematic review and meta-analysis of cohort studies American Journal of Clinical Nutrition, November 26, 2014    Clinical Article

9 Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: A randomized, double-blind, placebo-controlled, pilot clinical trial Journal of Affective Disorders, December 9, 2014    Clinical Article

10 Tea consumption and the risk of five major cancers: A dose-response meta-analysis of prospective studies Full Text BMC Cancer, March 18, 2014    Free full text    Evidence Based Medicine    Review Article

11 Dietary carrot consumption and the risk of prostate cancer European Journal of Nutrition, February 17, 2014    Clinical Article

12 Coffee consumption and prostate cancer risk: An updated meta-analysis Cancer Causes and Control, March 3, 2014    Evidence Based Medicine    Clinical Article

13 Systematic review of prostate cancer risk and association with consumption of fish and fish-oils: Analysis of 495,321 participants International Journal of Clinical Practice, December 16, 2014    Clinical Article

14 Impact of the 2012 United States preventive services task force statement on prostate-specific antigen screening: Analysis of urologic and primary care practices Urology, November 17, 2014    Clinical Article

15 Role of diet in prostate cancer: the epigenetic link Oncogene, December 24, 2014    Clinical Article

16 Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer: A nested case-control study Cancer Causes and Control, December 10, 2014    Clinical Article

17 Time to onset of clinically meaningful improvement with tadalafil 5mg once daily in the treatment of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: analysis of data pooled from four pivotal, double-blind, placebo-controlled studies The Journal of Urology, December 1, 2014    Clinical Article

18 The obesity paradox in the US population Full Text American Journal of Clinical Nutrition, May 2, 2013    Free full text    Review Article

19 Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: Outcome after long-term follow-up Psychiatry Research, December 2, 2014    Clinical Article

20 Long-term coffee consumption and risk of cardiovascular disease Circulation, February 11, 2014    Evidence Based Medicine    Review Article    Clinical Article

Indexed Journals in Family Medicine: American Family Physician, Archives of Family Med, Annals of Family Medmore

Make smarter career moves with less time.

Sign up for our free job placement service today and have a dedicated career consultant help locate the right physician job for you!
Click Here for more information.

Get Started Now!

Free-of-charge, no obligation.

Terms and Conditions For M3 Career Consult

By registering with the M3 Career Consult service you authorize M3 USA Corporation to represent you in your job search. The following is a summary of the terms of our service and our mutual obligations to help you find a job:

  • You designate M3 to act as your agent and represent you in your job search;
  • You will not pay us for this service
  • You will advise us of any companies or positions to which you apply or have applied;
  • You will advise us if you believe you are not capable of performing a position for which we submit you, or for which you interview;
  • You will keep all information we provide you about companies or positions strictly confidential;
  • You will promptly provide us with information we request of you;
  • You will make yourself reasonably available for phone, video and in-person conversations and interviews;
  • You will be truthful in all of your communications with us; and
  • You will advise us if anything above changes.
 

The Top Read Articles of 2014 are Now Available

Scouring thousands of peer-reviewed journals and popular press, Our Editors just released the Top Read Articles of the Year. See the Top Read List