The Role of Telmisartan & Its Combination in

Hypertension Management to Minimize

Complication

dr. Azimar Farhani SpJP, FIHA

HYPERTENSION
 “Rule of Halves”
Prevalence of Hypertension
in Indonesia = 34%*

Riskesdas 2018
 Definition
• SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg
• In the office or clinic

2020 ISH Global Hypertension Practice Guideline

 - Brain
HMOD - Heart
- Kidneys
Hypertension-Mediated Organ - Central and Peripheral Arteries
Damage - Eyes

2020 ISH Global Hypertension Practice Guideline

 • Reduce BP by at least 20/10
mmHg
Goal of • Reduce comorbidities and
complication of
Hypertension Hypertension
Therapy • Cardiac complication
• Renal complication

2020 ISH Global Hypertension Practice Guideline

 5 main classes of
antihypertensive drugs
CORE DRUG • ACEi
TREATMENT STRATEGY •
•
ARB
BB
FOR HYPERTENSION • CCB
• Diuretic

2020 ISH Global Hypertension Practice Guideline

2018 ESC/ESH Guidelines for the management of arterial hypertension
2020 ISH Global Hypertension Practice Guideline
 Meta analyses of RCTs including several hundred
thousand patients

⬇︎⬇︎↓ 10 mmHg
SBP • All mayor CV events by 20%
• All-cause mortality by 10-15%
• Stroke by 35%
• Coronary events by 20%, and
• Heart Failure by 40%
• Renal Failure by 28%
⬇︎⬇︎↓ 5 mmHg
DBP
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
RAAS System

Te Riet L, et al, Circulation Research, 2015

 ARB

Rysz J, et al, International Journal of Molecular Sciences, 2020

 CCB

Rysz J, et al, International Journal of Molecular Sciences, 2020

Telmisartan
Why is the better Sartan
TELMISARTAN
● A potent, long-lasting, nonpeptide antagonist of the angiotensin II
type-1 (AT1) receptor.
● Very high lipophilicity + high volume of distribution  clinically
important advantage of good tissue penetration.
● Not a prodrug and has a longer terminal elimination half-life
(~24 h)  suitable for once-daily dosing.
● Not metabolized by cytochrome P450 isoenzymes and has a low
risk for P450-based drug interactions.

Burnier M, the Journal of International Medical Research, 2009

Comparison of the half-lives of several ARB

Telmisartan has the longest half-life

among other ARBs, so a once-daily

dose is effective in controlling blood

pressure for 24 hours

Burnier M, the Journal of International Medical Research, 2009

Effect of Telmisartan to PPAR-ɣ

PPAR-ɣ agonists can improve insulin

sensitivity, reduce triglyceride levels
and decrease the risk for
atherosclerosis.
Telmisartan was the only ARB to
show strong (27-fold) activation.

Burnier M, the Journal of International Medical Research, 2009

TELMISARTAN Trial Landscape

Proven CardioProtective - RenoProtective

Weber M, Journal of Hypertension, 2003
TELMISARTAN
AMLODIPINE
Why is the better Combination??
 CCB as Antihypertensive Agent
• Calcium channel antagonists, also known as calcium channel
blockers (CCBs), have been widely used for many indications.
• These agents are often classified into two major categories,
• Non-dihydropyridines (Diltiazem, Verapamil) or
• Dihydropyridines (Amlodipine, Nifedipine)

• Amlodipine has good efficacy and safety, in addition to strong

evidence from large randomised controlled trials for cardiovascular
event reduction.
Fares H, et al, Open Heart, 2016
 Benefit of
Telmisartan-Amlodipine

Destro M, et al, Vascular Health and Risk Management, 2010

 Benefit of
Telmisartan-
Amlodipine
(vs Valsartan)

Telmisartan is more useful than valsartan as an Add-on agent for reducing the
level and variability of morning BP in patients on Amlodipine monotherapy

H Yoshida et al, Hypertension Research, 2013

 Benefit of
Telmisartan-
Amlodipine
(vs Candesartan)

Combination therapy with telmisartan plus VALSARTAN CANDESARTAN

amlodipine may be more beneficial than valsartan
or candesartan plus amlodipine treatment for
controlling BP, which could lead to more favorable
cardiovascular outcomes.

H Bekki et al, Oxidative Medicine and Cellular Longevity, 2010

 Benefit of SPC
(Telmisartan+Amlodipine)

Single-pill T/A provides substantial 24-hr BP lowering efficacy, >> patients

achieved 24-hour BP goals of <130/80mmHg.
The superior efficacy of combination therapy has been demonstrated in
those with moderate-to-severe HT, DM and obesity.
Combined use of T/A reduces the incidence of amlodipine-induced oedema

Suarez C, Drugs, 2011

 • The importance to detect
Hypertension (promotive,
preventive, curative and
Take home •
rehabilitative)
To give a proper therapy (agents
message and adherence)  SPC
• Initial therapy with combination
ACEi/ARB+CCB
• ARB+CCB have beneficial effect 
lowering BP effectively and reduce
edema
• But remember  use what is
available at your place
Thank You