University of Pavia, Clinica Medica II, Centro Ipertensione e Fisiopatologia Cardiovascolare, Department of Internal Medicine and Therapeutics, Piazzale Golgi 19, 27100 Pavia, Italy.
Expert Opin Pharmacother. 2011 Nov;12(16):2441-8. doi: 10.1517/14656566.2011.623698. Epub 2011 Sep 30.
The objective of this research was to evaluate the effect of telmisartan addition to amlodipine, on peripheral edema in hypertensive patients.
Seventy-five outpatients were randomized to amlodipine (A) 10 mg or telmisartan (T) 80 mg, or amlodipine 10 mg plus telmisartan 80 mg, for 6 weeks, in three crossover periods.
Blood pressure, ankle foot volume (AFV) and pretibial subcutaneous tissue pressure (PSTP) were evaluated, as were plasma norepinephrine and plasma active renin (PAR).
Amlodipine-telmisartan combination induced greater SBP/DBP reduction (-28.1/21.7 mmHg, p < 0.0001 vs baseline) compared with monotherapy with both amlodipine and telmisartan. Amlodipine monotherapy increased AFV by 26.7%, and PSTP by 83.2% (both p < 0.01). Adding telmisartan to amlodipine produced a significantly lesser increase in both AFV (+7.9%, p < 0.01 vs amlodipine) and PSTP (+23.8%, p < 0.01 vs amlodipine). Plasma norepinephrine levels were increased by amlodipine (+134.3 pg/ml, p < 0.01); such an increase was attenuated by the addition of telmisartan (+55 pg/ml, p < 0.05 vs amlodipine). PAR was slightly increased by amlodipine (+21.5 pg/ml, p < 0.05) and more by telmisartan alone (+62.5 pg/ml) and telmisartan-amlodipine combination (+71.3 pg/ml; both p < 0.01).
The addition of telmisartan to amlodipine significantly attenuated amlodipine-induced edema formation. The reduction of amlodipine-induced reflex-sympathetic activation by telmisartan might have contributed to such an effect.
本研究旨在评估替米沙坦联合氨氯地平对高血压患者外周水肿的影响。
75 例门诊患者随机分为氨氯地平（A）10mg 或替米沙坦（T）80mg，或氨氯地平 10mg 加替米沙坦 80mg，在 3 个交叉周期内进行 6 周治疗。
评估血压、踝足容积（AFV）和胫骨前皮下组织压（PSTP），以及血浆去甲肾上腺素和血浆活性肾素（PAR）。
与单药治疗相比，氨氯地平-替米沙坦联合治疗可使 SBP/DBP 降低更明显（-28.1/21.7mmHg，p<0.0001 与基线相比）。氨氯地平单药治疗可使 AFV 增加 26.7%，PSTP 增加 83.2%（均 p<0.01）。替米沙坦与氨氯地平联合使用可显著减少 AFV（+7.9%，p<0.01 与氨氯地平相比）和 PSTP（+23.8%，p<0.01 与氨氯地平相比）的增加。氨氯地平可使血浆去甲肾上腺素水平升高（+134.3pg/ml，p<0.01）；替米沙坦的加入可减弱这种升高（+55pg/ml，p<0.05 与氨氯地平相比）。PAR 轻度升高（+21.5pg/ml，p<0.05），而替米沙坦单药治疗（+62.5pg/ml）和替米沙坦-氨氯地平联合治疗（+71.3pg/ml；均 p<0.01）则更为明显。
替米沙坦与氨氯地平联合应用可显著减轻氨氯地平引起的水肿形成。替米沙坦降低氨氯地平引起的反射性交感神经激活可能有助于达到这种效果。
