Boehringer Ingelheim International GmbH & Co. KG, Ingelheim, Germany.
Curr Med Res Opin. 2013 Jan;29(1):41-53. doi: 10.1185/03007995.2012.750601. Epub 2012 Dec 6.
Hypertensive patients with metabolic risk factors, including obesity, diabetes, and metabolic syndrome, often require a combination of antihypertensive agents to achieve blood pressure (BP) targets. This article considers the evidence supporting telmisartan/amlodipine combination therapy for the treatment of hypertension in patients with metabolic risk factors.
Clinical trials of telmisartan/amlodipine at doses of 40-80 mg/5-10 mg (T40-80/A5-10) in free, fixed-dose and single-pill combinations were identified through electronic searches (MEDLINE and congress abstracts) up to and including June 2012, and from the Boehringer Ingelheim (BI) trial database. All identified trials were reviewed for data on hypertensive patients with obesity, diabetes, or both. Post-hoc subgroup analyses were carried out using the BI database to determine the relevant information if it was not previously reported.
Thirteen clinical trials including 6886 patients were identified with data relevant for inclusion in this review. The telmisartan/amlodipine combination allowed a high proportion of hypertensive patients with metabolic conditions to achieve BP targets, particularly among patients who had previously failed to achieve BP targets with monotherapy. BP reductions and goal rate achievement were similarly high among patients with and without the presence of metabolic risk factors. BP reductions were maintained throughout the 24 h dosing period, and 24 h goal rates were obtained in a high proportion of patients. Particularly large reductions in BP with telmisartan/amlodipine were recorded among patients with severe hypertension (systolic BP ≥180 mmHg).
The results of this post-hoc analysis further support the ability of the telmisartan/amlodipine combination to effectively reduce BP in hypertensive patients with obesity, diabetes, or metabolic syndrome, enabling the majority of patients to achieve target BP. This combination is also well tolerated, and may be considered a suitable option for these added-risk hypertensive patients.
患有代谢危险因素（包括肥胖、糖尿病和代谢综合征）的高血压患者通常需要联合应用降压药物以达到血压（BP）目标。本文探讨了支持使用替米沙坦/氨氯地平联合治疗合并代谢危险因素的高血压患者的证据。
通过电子检索（MEDLINE 和会议摘要），结合 Boehringer Ingelheim（BI）试验数据库，查找了剂量为 40-80mg/5-10mg（T40-80/A5-10）的替米沙坦/氨氯地平的自由、固定剂量和单片复方制剂的临床试验，检索时间截至 2012 年 6 月。对所有确定的试验均进行了综述，以获取有关肥胖、糖尿病或两者兼具的高血压患者的数据。如果之前未报告，则使用 BI 数据库进行事后亚组分析，以确定相关信息。
共确定了 13 项包含本综述纳入数据的临床试验，纳入了 6886 例患者。替米沙坦/氨氯地平联合治疗可使很大一部分合并代谢疾病的高血压患者达到血压目标，特别是在那些之前未能通过单药治疗达到血压目标的患者中。合并或不合并代谢危险因素的患者血压降低幅度和达标率均较高。替米沙坦/氨氯地平治疗后，24 小时血压持续降低，且大部分患者的 24 小时达标率较高。在严重高血压（收缩压≥180mmHg）患者中，替米沙坦/氨氯地平的降压幅度尤其显著。
本事后分析的结果进一步支持替米沙坦/氨氯地平联合治疗可有效降低肥胖、糖尿病或代谢综合征合并高血压患者的血压，使大多数患者达到目标血压。该联合治疗方案也具有良好的耐受性，可考虑作为这些存在附加风险的高血压患者的合适治疗选择。
