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The risk of cardiovascular disease events, including heart failure, myocardial infarction, stroke, and kidney disease, increases with increasing BP.[1] Reduction of BP with antihypertensive treatment reduces the risk of cardiovascular and renal morbidity and mortality. For most patients with hypertension, treatment with two or more antihypertensive agents will be required to achieve the desired level of BP reduction (to <140/90 mmHg for most hypertensive patients).[1]
The use of combinations of antihypertensive agents with complementary mechanisms of action can reduce BP significantly more than monotherapy.[2] An additional agent can be added when BP goals are not reached with a single antihypertensive treatment, or combination treatment may be used initially for patients who are considered likely to need treatment with more than one drug.[1] Historically, angiotensin II receptor antagonists have been combined with diuretics,[1] but more recently the angiotensin II receptor antagonist/calcium channel antagonist combination has been proven effective (reviewed by Bakris[3]) and several such combinations are available as single-pill combinations.[4-6] The use of a single-pill combination has been shown to improve patient compliance and treatment adherence,[7-9] which is a known problem with hypertension treatment,[10] and may also reduce healthcare costs.[9]
Telmisartan, an angiotensin II receptor antagonist, and amlodipine, a calcium channel antagonist, have well established efficacy in the treatment of hypertension as monotherapy[11-15] or in combination with other antihypertensive agents.[4,5,16-19] A single-pill combination of telmisartan/amlodipine (Twynsta ®) is available in the US and the EU for once-daily administration in adult patients with hypertension.[20,21] This review provides a brief overview of the pharmacologic properties of telmisartan and amlodipine, and discusses the available clinical trial data for combination treatment with telmisartan/amlodipine.
Medical literature on the use of telmisartan/amlodipine in hypertension was identified using MEDLINE and EMBASE, supplemented by AdisBase (a proprietary database). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug. Searches were last updated 1 November 2010.
1. Pharmacodynamic Profile
The pharmacodynamic effects of telmisartan and amlodipine that result in BP lowering are well established and have been reviewed elsewhere.[11-15] This section provides a brief overview of the mechanisms of action of telmisartan and amlodipine, with a focus on recent pharmacodynamic studies,...