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Summary
Hypertension is an important
public health challenge worldwide
Population (in millions)
with hypertension globally
In 2000,
> quarter of global
population with
hypertension
48%
Not treated (n = 2,458) Both are at equally
increased risk compared
with controlled BP
(p>0.05)
35%
BP uncontrolled
(n = 1,756)
17%
BP controlled (n = 872)
Non-compliance
to medication
regimens is
reduced by
24-26%
with fixed-dose
combinations
regimens
ESH/ESC 20132
• Combination of two antihypertensive drugs at fixed doses in a
single tablet may be recommended and favoured, because
reducing the number of daily pills improves adherence, which is
low in patients with hypertension.
Summary
Considerations of (Single-Pill) Combination
Therapy
• BP goal may be achieved more rapidly than with monotherapy1-4
• Greater reductions in BP1,2 and higher BP response and control rates3,4
vs monotherapy
• Reduced AEs due to lower doses of individual agents (lower doses
Benefits effective due to complementary mode of action 3,4
• Fixed-dose, single-pill combinations reduce pill burden,1,2 improved
compliance and treatment adherence,3,4 and may cost less than
individual components prescribed
Summary
CCB + ARB:
The Synergies of Counter-Regulation (1)
CCB
Arteriodilation
Peripheral oedema
Effective in low-renin patients
Reduces cardiac ischaemia
BP
CCB
Synergistic RAS activation
BP reduction No renal or CHF
Complementary benefits
clinical benefits
CCB
Arteriodilation ARB
Peripheral oedema RAS blockade
Effective in low-renin patients CHF and renal
Reduces cardiac ischaemia benefits
BP
ARB CCB
Venodilation Synergistic RAS activation
Attenuates peripheral oedema BP reduction minimal renal or
Effective in high-renin patients CHF benefits
Complementary
No effect on cardiac ischaemia
clinical benefits
Venous Fluid Leakage Induced by CCBs
…
Fluid leakage
Arterial No
dilation venous
(CCBs) dilation
Fluid leakage
Capillary bed
… Gets Reduced by Co-administration of ARBs
Arterial
Venous
dilation
dilation
(CCB and
(ARB)
ARB)
Capillary bed
Telmisartan Plus Amlodipine Phase III/IV Clinical Trials
Programme
22
Telmisartan + Amlodipine : Provides consistent BP
Reductions across hypertension severities
Telmisartan Plus Amlodipine Provides Consistently High BP
Reductions in Hypertensive at-Risk Patients
-10
baseline (mmHg)
-20
-30
-40
-43.2 -44.2 -46,1
-50 -46,8 -46,6 -47,5
T80/A10
-60
80%*
–37.9 mmHg
147.7 Week 2
–47.5 mmHg
137.9 Week 8
* p<0.0001 vs amlodipine 10 mg
Littlejohn et al. J Clin Hypertens. 2009;11:207–213.
Agenda
Summary
Summary