Beneficial cardiometabolic actions of telmisartan plus amlodipine therapy in elderly patients with poorly controlled hypertension

Abstract

Background: There is a growing body of evidence that blood pressure (BP) level is one of the major determinants of cardiovascular morbidity and mortality in individuals, including elderly people. However, to achieve a target BP level in the elderly is more difficult compared with patients aged <65 years. Current guidelines recommend combination drug therapy with different modes of action for the treatment of elderly patients with moderate hypertension (HT). However, the optimal combination regimen is not well established in elderly HT.

Hypothesis: We hypothesized that combination therapy of telmisartan plus amlodipine would exert favorable cardiometabolic actions in elderly HT.

Methods: Seventeen elderly patients with essential HT who failed to achieve a target home BP level with treatment of 5 mg amlodipine plus 80 mg valsartan or 8 mg candesartan for at least 2 months were enrolled. Then the patients were assigned to replace their valsartan or candesartan with 40 mg telmisartan. The subjects were instructed to measure their own BP at home every day during the study periods.

Results: Replacement of valsartan or candesartan by telmisartan in amlodipine-treated elderly hypertensive patients showed a significant reduction in morning home systolic BP and evening home systolic and diastolic BP at 12 weeks. Switching to telmisartan significantly increased serum adiponectin level.

Conclusions: Our present study suggests that combination therapy with telmisartan plus amlodipine may exert more beneficial cardiometabolic effects in elderly patients with HT compared with valsartan or candesartan plus amlodipine treatment.

Figure 1

Morning (A) and evening (B) home BP levels at baseline and after telmisartan treatment. Replacement of valsartan or candesartan with telmisartan showed a significant reduction in morning SBP and evening SBP and DBP at 12 weeks. Abbreviations: BP, blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure. ^a The * indicates P < 0.05 compared with baseline values. ^b The ** indicates P < 0.001 compared with baseline values.

Figure 2

Serum adiponectin levels of each subject at baseline and after telmisartan treatment. Replacement of valsartan or candesartan with telmisartan showed a significant increase in serum adiponectin levels at 12 weeks.

Figure 3

Correlation of the changes in serum adiponectin (Δadiponectin) obtained by switching from valsartan or candesartan to telmisartan therapy with those in morning (A) and evening (B) MBP (ΔMBP). Δadiponectin was not correlated with morning (A) or evening (B) ΔMBP. Abbreviations: MBP, mean blood pressure; R², coefficient of determination.