Efficacy and tolerability of «step down» antihypertensive therapeutic approach using Telmisartan in hypertensive patients with metabolic syndrome

Objective. To compare efficacy and tolerability of «step-down» approach starting from initial antihypertensive therapy with fixed dose combination of telmisartan 80 mg (T80) and hydrochlorothiazide 12,5 mg (HCTZ) and «step-by-step» approach starting from T40 to T80/HCTZ. Design and methods. 60 previously uncontrolled hypertensive patients (men 60 %, smoking 40 %, mean age — 48,0 ± 5,8 years) with metabolic syndrome (ESH 2007, body mass index — 30,1 ± 8,9 kg m², waist circumference — 97,9 ± 8,8 cm, total cholesterol — 6,4 ± 0,8 mmol/l, triglycerides — 1,9 ± 1,0 mmol/l, high-density lipoprotein — 1,5 ± 0,4 mmol/l, low-density lipoprotein — 4,0 ± 0,8 mmol/l, glucose — 5,7 ± 0,6 mmol/l) were randomized for T 80/HCTZ 12,5 mg (group 1) once daily or T 40 mg (group 2) once daily. Blood pressure was assessed by home self- monitoring. In group 1 step-down strategy with switching to T80 and then to T40 under home blood pressure monitoring was implemented. In group 2 traditional up-titration strategy was applied. Results. Both groups were comparable by office blood pressure levels (group 1 — 164,3 ± 5,0/92,8 ± 3,9 mm Hg, group 2 — 165,7 ± 6,7/93,0 ± 4,1 mm Hg) and home self-monitoring data (group 1 — 153,7 ± 2,9/90,9 ± 4,5 mm Hg, group 2 — 154,7 ± 3,87/91,0 ± 4,6 mm Hg). Start of treatment with T 80/HCTZ 12,5 resulted in faster blood pressure control achievement and lower rates of masked uncontrolled hypertension assessed by clinic BP measurement and home BP monitoring. 20 (66,7 %) patients of group 1 managed to withdraw HCTZ, and 10 (33,3 %) subjects decreased Telmisartan to 40 mg daily. In group 2 Telmisartan was increased up to 80 mg daily in all patients at week 4, and by week 24 combination therapy was administered to 22 (73,3 %) subjects. Step-down approach was safe and well tolerated. Conclusion. Step-down approach of initial antihypertensive therapy is feasible in previously untreated hypertensive subjects with metabolic syndrome.

combination therapy, monotherapy, home blood pressure monitoring, angiotensin II receptors antagonists

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