Telmisartan and Amlodipine: Combination Therapy for Hypertension

According to WHO, hypertension is one of the most prevalent causes of death globally. It is the most common CVS disorder and accounts for 10.8 % of all death.
In India, it is responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD).
Let us know about this disorder!

What is hypertension?
Hypertension or high blood pressure is a cardiovascular disorder, the normal blood pressure of a person is 120 (Systolic) over 80 (Diastolic) mmHg, which is necessary to force the blood to various tissue and organs for the delivery of oxygen and nutrients. Whereas the blood pressure higher than 140 over 90 mmHg, results due to hypertension (high blood pressure).

It is a big challenge to manage a chronic disease like hypertension; as it leads to multiple complications like myocardial infarction, atherosclerosis, stroke, heart attack and death. Considerable efforts from the physician as well as the patient, are required for the effective management of hypertension.

The various lifestyle changes such as increased physical activity, low sodium intake in the diet, and quitting smoking as well as alcohol are beneficial to control high blood pressure. Along with all these modifications, the patient also needs medications for the treatment of hypertension and the improvement of health. Moreover, some combinations of medicines are used as a treatment option to manage this complex chronic disorder.

Role of Combination therapy for hypertension
Combination therapy for hypertension includes fixed-dose combinations which lower the blood pressure more quickly and decreases the adverse effects. In the combination therapy, two or more antihypertensive agents from different classes are combined in low doses which reduces the incidence of adverse events related to other drugs. It also enhances the antihypertensive effects of medicament by two to five times.
For example, when calcium channel blockers (CCB) and diuretic combination, the incidence of oedema (a severe adverse effect related to CCB) get reduced when it is given in combination with diuretics.

When is the combination therapy needed?

• If the patients have a comorbid condition, then they require more than one antihypertensive agent.
• To avoid severe complications related to monotherapy
• To achieve the maximum therapeutic effectiveness in a short period with minimum side-effects

If the dose of monotherapy is increased, the coronary events decrease by 29 %, while combining two antihypertensive drugs having a different mechanism of action reduces the coronary events by 40%.
Instead of increasing the dose of monotherapy, the use of combination therapy helps to prevent non-specific organ toxicity and offers a faster control of blood pressure.

Combination therapy has proven beneficial in the management of hypertension, an excellent example of such combination therapy are Telmisartan and Amlodipine.

So let us enlighten you,
Combination of Telmisartan and Amlodipine
There are various classes of antihypertensive drugs such as beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, diuretics, angiotensin receptor blockers and many more. Each class have unique features with few or more side effects.

For lowering the blood pressure quickly with least or no side effects, there is a fixed-dose combination of Telmisartan and Amlodipine. It is the most prescribed antihypertensive drugs in combination therapy.

Telmisartan and Amlodipine is a single pill combination which is taken orally once in a day. The use of Telmisartan and Amlodipine in low doses provides a superior reduction in blood pressure. It lowers the high blood pressure and prevents stroke, kidneys problems and heart attack.

Mechanism of action of Telmisartan and Amlodipine

Telmisartan is angiotensin receptor blocker (ARB), and Amlodipine is calcium channel blocker (CCB). Both have a different mechanism of action to relax the blood vessels for smooth blood flow.

• Telmisartan targets the renin-angiotensin system (RAS) and modulates the vasopressor activity of angiotensin II. It prevents the angiotensin II from binding its receptor, which ultimately blocks the vasoconstriction and aldosterone secretion from angiotensin II.
• Whereas, Amlodipine works by relaxing the blood vessels and muscles of the heart. Amlodipine increases the production of nitric oxide, which is an efficient vasodilator that decreases blood pressure. It has selectivity for peripheral blood vessels which reduces the risk of cardiac conduction abnormalities.

Benefits of Telmisartan and Amlodipine Combination therapy

• Offers sustained action, a single tablet is required per day because of both possess long half-lives of 20-30 hours
• Increases patient compliance
• In patients with mild to moderate hypertension, provides an effective reduction in blood pressure
• Generally, it is well tolerated
• This combination is appropriate for those with diabetes or metabolic syndrome as it does not worsen the metabolic complications associated with diabetes

Dosage of Telmisartan and Amlodipine:
The dose is initiated with 40 mg (Telmisartan) and 5 mg (Amlodipine). It may be increased after two weeks but not exceeded than 80 mg (Telmisartan) and 10 mg (Amlodipine) per day.
Dose range: 20-80 mg for Telmisartan and 2.5-10 mg for Amlodipine per day

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