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.
Are you sure you want to Unfollow 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 A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients International Journal of Impotence Research: The Journal of Sexual Medicine, August 12, 2014    Clinical Article

2 Midlife dietary vitamin D intake and subsequent performance in different cognitive domains Annals of Nutrition and Metabolism, September 16, 2014    Clinical Article

3 Aromatherapy for stress reduction in healthy adults: A systematic review and meta-analysis of randomized clinical trials Maturitas, September 3, 2014    Evidence Based Medicine

4 Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: A randomized, double-blind, placebo-controlled, stratified, parallel-group trial Journal of Child Psychology and Psychiatry, September 8, 2014    Clinical Article

5 High risk of failing eradication of Helicobacter pylori in patients with diabetes: A meta-analysis Diabetes Research and Clinical Practice, August 18, 2014    Review Article

6 Proportion of tadalafil-treated patients with clinically meaningful improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia - integrated data from 1499 study participants BJU International, September 12, 2014    Clinical Article

7 Single animal to human transmission event responsible for 2014 Ebola outbreak Full Text NIH News, September 2, 2014    Free full text

8 National trends in the management of low- and intermediate-risk prostate cancer in the United States The Journal of Urology, August 13, 2014    Clinical Article

9 Plasma tocopherols and risk of prostate cancer in the selenium and vitamin E cancer prevention trial (SELECT) Cancer Prevention Research, August 25, 2014    Clinical Article

10 The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: Results from a randomized controlled trial Psychiatry Research, August 4, 2014    Clinical Article

11 Neuroendocrine prostate cancer (NEPC) progressing from conventional prostatic adenocarcinoma: Factors associated with time to development of NEPC and survival from NEPC diagnosis-a systematic review and pooled analysis Journal of Clinical Oncology, September 22, 2014    Evidence Based Medicine    Review Article

12 Rapid and durable protection against Ebola virus with new vaccine regimens Full Text National Institute of Allergy and Infectious Disease - News, September 9, 2014    Free full text

13 Comparison of brain structural variables, neuropsychological factors, and treatment outcome in early-onset versus late-onset late-life depression The American Journal of Geriatric Psychiatry, September 18, 2014    Clinical Article

14 Adjunctive triple chronotherapy (combined total sleep deprivation, sleep phase advance, and bright light therapy) rapidly improves mood and suicidality in suicidal depressed inpatients: An open label pilot study Journal of Psychiatric Research, September 19, 2014    Clinical Article

15 Urinating standing versus sitting: Position is of influence in men with prostate enlargement. A systematic review and meta-analysis PLOS ONE, August 1, 2014    Evidence Based Medicine    Review Article
Exclusive Author Commentary

16 Effects of alcohol consumption on cognition and regional brain volumes among older adults American Journal of Alzheimer's Disease and Other Dementias, September 18, 2014    Clinical Article

17 Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96–02/AUO AP 09/95 Trial Full Text European Urology, July 18, 2014    Free full text    Clinical Article

18 The use of metformin in patients with prostate cancer and the risk of death Cancer Epidemiology, Biomarkers & Prevention, September 22, 2014    Clinical Article

19 Metformin in chemotherapy-naive castration-resistant prostate cancer: A multicenter phase 2 trial (SAKK 08/09) Full Text European Urology, August 15, 2014    Free full text    Clinical Article

20 Curcumin for the treatment of major depression: A randomised, double-blind, placebo controlled study Journal of Affective Disorders, July 16, 2014    Clinical Article

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

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close