Effect of a fixed-dose combination of Telmisartan/S-amlodipine on circadian blood pressure compared with Telmisartan monotherapy: TENUVA-BP study

Bong-Joon Kim, Kyoung-Im Cho, Hyuck Moon Kwon, Seung-Min Choi, Chang-Hwan Yoon, Sang Wook Lim, Seung-Jae Joo, Nam Ho Lee, Sang-Yup Lim, Seong-Hoon Lim, Hyo-Soo Kim, Bong-Joon Kim, Kyoung-Im Cho, Hyuck Moon Kwon, Seung-Min Choi, Chang-Hwan Yoon, Sang Wook Lim, Seung-Jae Joo, Nam Ho Lee, Sang-Yup Lim, Seong-Hoon Lim, Hyo-Soo Kim

Abstract

Background: This study evaluated the circadian efficacy of a telmisartan 40 mg/S-amlodipine 2.5 mg fixed-dose combination (Telmisartan40/S-Amlodipine2.5) compared to telmisartan 80 mg (Telmisartan80) in patients with essential hypertension who did not respond to 2-4 weeks' treatment with telmisartan 40 mg.

Methods: Eligible patients with essential hypertension (clinic mean sitting systolic blood pressure [MSSBP] ≥140 mmHg, or ≥ 130 mmHg in those with diabetes mellitus or chronic kidney disease) were randomly assigned to Telmisartan40/S-Amlodipine2.5 or Telmisartan80 for 8 weeks. All patients underwent ambulatory BP monitoring (ABPM) at baseline and 8 weeks later. Primary endpoints were changes in mean 24-h SBP and DBP on 24-h ABPM from baseline after 8 weeks. Secondary endpoints were changes in daytime, nighttime, and morning SBP and DBP, and clinic MSSBP and MSDBP.

Results: A total of 316 Korean patients were enrolled, 217 patients were randomized to treatment, and 192 patients completed the study. Compared to Telmisartan80, Telmisartan40/S-Amlodipine2.5 showed significantly better reductions in 24-h mean SBP and DBP after 8 weeks. Telmisartan40/S-Amlodipine2.5 also significantly reduced secondary endpoints compared to Telmisartan80. Among 15 adverse events (7 [Telmisartan40/S-Amlodipine2.5] and 8 [Telmisartan80]), there were five adverse drug reactions; 14 events were mild, and none were identified with significant between-group differences.

Conclusions: Telmisartan40/S-Amlodipine2.5 was tolerable and more effective than Telmisartan80 in lowering 24-h mean ambulatory BP in patients with essential hypertension not responding adequately to Telmisartan40. Our findings support the fact that the combination of S-amlodipine with telmisartan is more appropriate than increasing the dose of telmisartan monotherapy.

Trial registration: ClinicalTrials.gov , NCT02231788 . Registered 4 September 2014.

Keywords: Amlodipine; Circadian rhythm; Drug combinations; Essential hypertension; Telmisartan.

Conflict of interest statement

All authors declare that they have no conflicts of interest regarding the content of this article.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Patient disposition. T40/SA2.5, Telmisartan40/S-Amlodipine2.5; T80, Telmisartan80; FA, full analysis; PP, per protocol. Note: †Because there are duplicate subjects, the sum of each item is greater than the sum of the total
Fig. 2
Fig. 2
Comparison of changes in 24-h mean SBP/DBP according to treatment groups. SBP, systolic blood pressure; DBP, diastolic blood pressure; T40, Telmisartan40; SA2.5, S-Amlodipine2.5; T80, Telmisartan80

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