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Antihypertensive and Target-Organ Protective Properties of Telmisartan and Hydrochlorothiazide Single-Pill Combination

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The most important result of the revision of the European and Russian guidelines for the management of arterial hypertension (AH) was a special focus on initializing antihypertensive treatment with single-pill combinations (SPCs) in majority patients with AH. Combination of the angiotensin II receptor blocker and thiazide diuretic is one of the possible first line SPCs in the absence of specific clinical conditions according to the new guidelines. In this regard, SPC of telmisartan and hydrochlorothiazide (HCT), worth special noticing in the classes of sartans and thiazide diuretics, since both drugs have a long clinical experience and large body of evidence of antihypertensive efficacy and safety, as well as telmisartan also has a number of superior target-organ protective and metabolic properties distinguishing it from other members of the class. In real clinical practice TANDEM study telmisartan and its SPC with HCT showed high antihypertensive efficacy and good tolerability in patients with all AH grades and with isolated systolic AH and allowed to achieve target blood pressure levels in the most of patients. Long-lasting effect is another essential characteristic of telmisartan, this feature allows to control blood pressure throughout the day, including the morning surge, which is the most “dangerous” in terms of cardiovascular risk. Telmisartan also provide powerful target-organ protection realized at the level of all AH target-organs. Finally, another unique pharmacological property of telmisartan and its combination with HCT is a favourable effect on the carbohydrate and lipid profile, which comprises of increasing tissue sensitivity to insulin, normalizing blood glucose levels, reducing blood total cholesterol, low-density lipoprotein cholesterol and triglycerides and thereby reducing risk of atherosclerosis development and progression. Telmisartan/HCT SPC should be recommended for wide use in hypertensive patients to control blood pressure, protect end-organs, improve prognosis and reduce cardiovascular risk due to its high antihypertensive efficacy, the ability to provide the large target-organ protection and a beneficial metabolic effect.

About the Authors

O. D. Ostroumova
Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology; I.M. Sechenov First Moscow State Medical University (Sechenov University
Russian Federation

Olga D. Ostroumova – MD, PhD, Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University; Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University

Pervaya Leonova ul. 16, Moscow, 129226 ; 

Trubetskaya ul. 8-2, Moscow, 119991 Russia

A. I. Kochetkov
Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology
Russian Federation

Alexey I. Kochetkov – MD, PhD, Researcher, Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University; Assistant, Chair of Aging Diseases, Pirogov Russian National Research Medical University

Pervaya Leonova ul. 16, Moscow, 129226 Russia


1. Williams B., Mancia G., Spiering W., et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021-04. DOI:10.1093/eurheartj/ehy339.

2. Chazova I.E., Zhernakova Y.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019;16(1):6-31 (In Russ.). DOI:10.26442/2075082X.2019.1.190179.

3. Zhou D., Xi B., Zhao M., et al. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III Linked Mortality Study. Sci Rep. 2018;8(1):9418. DOI:10.1038/s41598-018-27377-2.

4. Zaletel A., Knavs Vrhunec P., Barbič-Žagar B. Achieving Blood Pressure Control with Telmisartan and Fixed Dose Combination of Telmisartan and Hydrochlorothiazide. Cardiol Croat. 2016;11(1011):594-7. DOI:10.15836/ccar2016.594.

5. Kjeldsen S.E., Schumacher H., Neldam S., Guthrie R.M. Telmisartan/Hydrochlorothiazide combination therapy for the treatment of hypertension: a pooled analysis in older and younger patients. J Clin Hypertens (Greenwich). 2013;15(6):380-8. DOI:10.1111/jch.12089.

6. Parati G., Stergiou G., O'Brien E., et al; European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32(7):1359-66. DOI:10.1097/HJH.0000000000000221.

7. Clement D.L., De Buyzere M.L., De Bacquer D.A., et al. Office versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407-15. DOI:10.1056/NEJMoa022273.

8. Sega R., Facchetti R., Bombelli M., et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005;111(14):1777-83. DOI:10.1161/01.CIR.0000160923.04524.5B.

9. White W.B., Giles T., Bakris G.L., et al. Measuring the efficacy of antihypertensive therapy by ambulatory blood pressure monitoring in the primary care setting. Am Heart J. 2006;151(1):176-84. DOI:10.1016/j.ahj.2005.02.014.

10. Sharma A.M., Davidson J., Koval S., Lacourcière Y. Telmisartan/hydrochlorothiazide versus valsartan/hydrochlorothiazide in obese hypertensive patients with type 2 diabetes: the SMOOTH study. Cardiovasc Diabetol. 2007;6:28. DOI:10.1186/1475-2840-6-28.

11. Burnier M., Brunner H.R. Angiotensin II receptor antagonists. Lancet. 2000;355(9204):637-45. DOI:10.1016/S0140-6736(99)10365-9.

12. Ostroumova О.D., Kochetkov A.I., Smolyarchuk E.A., Koniev Т.I. Telmisartan in cardiovascular risk reduction. Cardiovascular Therapy and Prevention. 2018;17(1):87-96 (In Russ.). DOI:10.15829/1728-8800-2018-1-87-96.

13. Peixoto A.J., White W.B. Circadian blood pressure: clinical implications based on the pathophysiology of its variability. Kidney Int. 2007;71(9):855-60. DOI:10.1038/

14. Willich S.N., Levy D., Rocco M.B., et al. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol. 1987;60:801-6. DOI:10.1016/00029149(87)91027-7.

15. Elliott W.J. Circadian variation in the timing of stroke onset. А meta-analysis. Stroke. 1998;29:9926. DOI:10.1161/01.STR.29.5.992.

16. Kario K. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives. Hypertension. 2010;56(5):765-73. DOI:10.1161/HYPERTENSIONAHA.110.157149.

17. Neldam S., Edwards C.; ATHOS Study Group. 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(3):151-60. DOI:10.1111/j.1076-7460.2006.05219.x.

18. Petrovic I., Petrovic D., Vukovic N., et al. Ventricular and vascular remodelling effects of the angiotensin II receptor blocker telmisartan and/or the angiotensin-converting enzyme inhibitor ramipril in hypertensive patients. J Int Med Res. 2005;33 Suppl 1:39A-49A. DOI:10.1177/14732300050330S106.

19. Galzerano D., Tammaro P., del Viscovo L., et al. Three-dimensional echocardiographic and magnetic resonance assessment of the effect of telmisartan compared with carvedilol on left ventricular mass a multicenter, randomized, longitudinal study. Am J Hyperten. 2005;18(12):1563-9. DOI:10.1016/j.amjhyper.2005.06.011.

20. Yusuf S., Teo K., Anderson C., et al. Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet. 2008;372(9644):1174-83. DOI:10.1016/S0140-6736(08)61242-8.

21. Boutouyrie P., Tropeano A.I., Asmar R., et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10-5.

22. Laurent S., Boutouyrie P., Asmar R., et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.

23. Kinouchi K., Ichihara A., Sakoda M., et al. Effects of telmisartan on arterial stiffness assessed by the cardio-ankle vascular index in hypertensive patients. Kidney Blood Press Res. 2010;33(4):304-12. DOI:10.1159/000316724.

24. Asmar R., Gosse P., Topouchian J., et al. Effects of telmisartan on arterial stiffness in Type 2 diabetes patients with essential hypertension. J Renin Angiotensin Aldosterone Syst. 2002;3(3):176-80. DOI:10.3317/jraas.2002.038.

25. Redón J., Luque-Otero M., Martell N., Chaves F.J.; POLPRI Investigators. Renin-angiotensin system gene polymorphisms: relationship with blood pressure and microalbuminuria in telmisartan-treated hypertensive patients. Pharmacogenomics J. 2005;5(1):14-20. DOI:10.1038/sj.tpj.6500280.

26. Bakris G., Burgess E., Weir M. et al.; AMADEO Study Investigators. Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy. Kidney Int 2008;74(3):3649. DOI:10.1038/ki.2008.204.

27. Schmieder R.E., Delles C., Mimran A., et al. Impact of telmisartan versus ramipril on renal endothelial function in patients with hypertension and type 2 diabetes. Diabetes Care. 2007;30(6):1351-6. DOI:10.2337/dc06-1551.

28. Cupisti A., Rizza G.M., D'Alessandro C., et al. Effect of telmisartan on the proteinuria and circadian blood pressure profile in chronic renal patients. Biomed Pharmacother. 2003;57(3-4):169-72. DOI:10.1016/S0753-3322(03)00013-1.

29. Rysavá R., Tesar V., Merta M.; Czech Group for the Study of Glomerulonephritis. Effect of telmisartan on blood pressure control and kidney function in hypertensive, proteinuric patients with chronic kidney disease. Blood Press Monit. 2005;10(4):207-13.

30. 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(3):177-85. DOI:10.1038/sj.jhh.1001964.

31. Benson S.C., Pershadsingh H.A., Ho C.I., et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity. Hypertension. 2004;43(5):993-1002. DOI:10.1161/01.HYP.0000123072.34629.57.

32. Jugdutt B.I. Clinical effectiveness of telmisartan alone or in combination therapy for controlling blood pressure and vascular risk in the elderly. Clin Interv Aging. 2010;5:403-16. DOI:10.2147/CIA.S6709.

33. Wakino S., Ronald E. L., Hsueh W.A. Vascular protective effects by activation of nuclear receptor PPARγ. Journal of Diabetes and its Complications. 2002;16(1):46-9. DOI:10.1016/S10568727(01)00197-0.

34. Hsueh W.A., Law R. The central role of fat and effect of peroxisome proliferator-activated receptorgamma on progression of insulin resistance and cardiovascular disease. Am J Cardiol. 2003;92(4A):3J-9J. DOI:10.1016/S0002-9149(03)00610-6.

35. Schiffrin E.L., Amiri F., Benkirane K., et al. Peroxisome proliferator-activated receptors. Hypertension. 2003;42(4):664-668. DOI:10.1161/01.HYP.0000084370.74777.B6.

36. Vitale C., Mercuro G., Castiglioni C., et al. Metabolic effect of telmisartan and losartan in hypertensive patients with metabolic syndrome. Cardiovascular Diabetology. 2005;4:6. DOI:10.1186/1475-2840-4-6.

37. Miura Y., Yamamoto N., Tsunekawa S., et al. Replacement of valsartan and candesartan by telmisartan in hypertensive patients with type 2 diabetes: metabolic and antiatherogenic consequences. Diabetes Care. 2005;28(3):757-8. DOI:10.2337/diacare.28.3.757.

38. Derosa G., Cicero A.F., D'Angelo A., et al. Telmisartan and irbesartan therapy in type 2 diabetic patients treated with rosiglitazone: effects on insulin-resistance, leptin and tumor necrosis factor-alpha. Hypertens Res. 2006;29(11):849-56. DOI:10.1291/hypres.29.849.

39. Derosa G., Ragonesi P.D., Mugellini A., et al. Effects of telmisartan compared with eprosartan on blood pressure control, glucose metabolism and lipid profile in hypertensive, type 2 diabetic patients: a randomized, double-blind, placebo-controlled 12-month study. Hypertens Res. 2004;27(7):457464. DOI:10.1291/hypres.27.457.

40. Derosa G., Cicero A.F., Bertone G., et al. Comparison of the effects of telmisartan and nifedipine gastrointestinal therapeutic system on blood pressure control, glucose metabolism, and the lipid profile in patients with type 2 diabetes mellitus and mild hypertension: a 12-month, randomized, doubleblind study. Clin Ther. 2004;26(8):1228-36. DOI:10.1016/S0149-2918(04)80049-3.

41. Ramesh R., Sarala N., Venkatarathnamma P.N. Efficacy and safety of olmesartan and hydrochlorothiazide versus telmisartan and hydrochlorothiazide in newly diagnosed patients with mild-to-moderate hypertension. International Journal of Pharmaceutical Investigation. 2018;8(1):38-43. DOI:10.4103/jphi.JPHI_4_18.

For citation:

Ostroumova O.D., Kochetkov A.I. Antihypertensive and Target-Organ Protective Properties of Telmisartan and Hydrochlorothiazide Single-Pill Combination. Rational Pharmacotherapy in Cardiology. 2019;15(4):558-567. (In Russ.)

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