CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
AFRICA
167
New telmisartan/amlodipine single-pill combination offers both
efficacy and tolerability
The supporting data for the use of the
single-pill combination of telmisartan/
amlodipine once daily in poorly controlled
hypertensive patients is extensive and
provides clinicians with an effective step-
up anti-hypertensive treatment for these
patients.
1-4
This combination is approved
in the European Union, the United States
and Japan, for the treatment of adult
patients with hypertension.
The ADIS drug profile
3
reviews the
pharmacodynamic, pharmacokinetic and
therapeutic efficacy of this combination.
It summarises the key elements support-
ing the use of this combination in patients
uncontrolled on either an ARB or a CCB
and as initial therapy in patients likely to
require multiple drugs to achieve their
blood pressure control (Table 1).
A clinical study of the combination
also undertaken in South Africa,
4
present-
ed at the ESC congress last year, moni-
tored the efficacy of the single tablet with
ambulatory blood pressure monitoring
(ABPM) and highlighted efficacy and
the 24-hour anti-hypertensive action of
the combination. Almost 1 500 patients
participated in the trial, of whom a third
were evaluated using APBM.
The combination treatment of
telmisartan 20 mg plus amlodipine 2.5
mg, telmisartan 40 mg plus amlodipine 5
mg, and telmisartan 80 mg plus amlodi-
pine 10 mg resulted in additive reductions
compared to the corresponding monother-
apies. The combination was consistently
more effective at lowering 24-hour mean
diastolic and systolic blood pressures
throughout the 24-hour dosing interval.
Tolerability
Of particular interest to both clinicians and
patients is the expected observation that
general oedema occurred in significantly
fewer patients who were on amlodipine 5
mg and were then switched to the telmisar-
tan 40 mg plus amlodipine 5 mg combi-
nation, compared to oedema complica-
tions of up-titration to 10 mg amlodi-
pine daily.
5
The combination therapy was
generally well tolerated in patients, with
adverse reactions (headache and periph-
eral oedema were the most common)
being mild and transient in nature.
As pharmaceutical companies increas-
ingly respond to the need for combina-
tion single-pill antihypertensive therapy, a
published study of switching to telmisar-
tan/amlodipine from other combinations
in poorly controlled patients makes for
interesting reading.
2
While the study was
conducted in Japanese patients and the
numbers were small, the study suggested
that combination therapy with telmisartan
plus amlodipine may be more benefi-
cial than valsartan or candesartan plus
amlodipine treatment for controlling
brachial and central aortic blood pressure.
J Aalbers, Special Assignments Editor
1.
Telmisartan/amlodipine single-pill combi-
nation: a guide to its use in hypertension.
Drugs Ther Perspec
2011;
27
(5): 5–9.
2.
Bekki H, Yamamoto K, Sone M, Hammo
T, Nakata M,
et al
. Efficacy of combination
therapy with telmisartan plus amlodipine in
patients with poorly controlled hyperten-
sion.
Oxidative Med Cell Longev
2010;
3
(5):
342–346.
3.
Moen MD. Telmisartan/amlodipine. Single-
pill combination in hypertension.
Am J
Cardiovasc Drugs
2010;
10
(6): 401–412.
4.
Littlejohn III T, Majul CR, Oigman W,
Olvera R, Seeber M,
et al
. Combination
therapies of telmisartan and amlodipine are
effective at lowering 24-hour blood pres-
sure: findings of an ABPM stub-study in
hypertensive patients. ESC 2010.
5.
Neldam S, Lang M, Jones R, on behalf of
the TEAMSTA-5 investigators. Telmisartan
and amlodipine single-pill combination vs
amlodipine monotherapy for superior blood
pressure lowering and improved tolerability
in patients with uncontrolled hypertension:
results of the TEAMSTA-5 study.
J Clin
Hypertens
. Published online 22 Apr 2011.
DOI: 10.1111/j.1751-7176.2011.00468.x
TABLE 1. AIDS EVALUATION
Key clinical benefits of single-pill telmisar-
tan/amlodipine in hypertension
• Convenient once-daily administration of
a single tablet, with potential compliance
benefits.
• Components have different and comple-
mentary mechanisms of action.
• Provides effective reductions in blood
pressure in patients with mild to severe
hypertension.
• Effectively lowers blood pressure in
patients with an adequate response to
telmisartan or amlodipine monotherapy.
• Generally well tolerated.
Diary for 2011 cardiovascular congresses
DATE
PLACE
CONFERENCE
WEBSITE
22 June
Frankfurt, Germany
Imaging in Cardiovascular Interventions (ICI)
/
27–31 August
Paris, France
European Society of Cardiology congress (ESC)
/
29 September –
1 October
Sri Lanka
Asia Pacific Stroke conference
23–26 October
International Convention
Centre, East London,
South Africa
SA Heart congress
12–16 November Orlando, Florida, USA American Heart Association (AHA)
