Metabolic effect of combined telmisartan and nifedipine CR therapy in patients with essential hypertension

Yuji Shimizu,^1,4 Fumiyasu Yamasaki,⁴ Takashi Furuno,^1,4 Toru Kubo,¹ Takayuki Sato,^3,4 Yoshinori Doi,¹ Tetsuro Sugiura<sup>2

1</sup>Medicine and Geriatrics, ²Clinical Laboratory, ³Cardiovascular Control, Kochi Medical, School, Nankoku, Japan; ⁴Section of Cardiology, Inoue Hospital, Takaoka, Japan

Background: In addition to exerting a blood pressure (BP)-lowering effect, telmisartan produces favorable metabolic effects via peroxisome proliferator-activated receptor γ activation. While a combination of telmisartan and a calcium channel blocker is often used to achieve a target BP level, the metabolic effects of this drug combination remain unclear. Therefore, this study evaluated the metabolic effects of telmisartan plus nifedipine controlled release (CR) therapy, in hypertensive patients without metabolic disease.
Methods: Sixteen patients with essential hypertension, who had not undergone antihypertensive therapy in the previous 6 months, were studied. Patients were initiated on telmisartan (40 mg/day). If their office BP was not reduced to 140/90 mmHg after 6 weeks, nifedipine CR (20–40 mg per day) was added for 18 weeks. The other patients whose BP had achieved the target of 140/90 mmHg, continued only telmisartan.
Results: Telmisartan reduced BP (174 ± 13/92 ± 10 to 143 ± 22/78 ± 11 mmHg; P < 0.01) at 6 weeks in 16 patients, but eight patients did not achieve target BP levels and required addition of nifedipine. Telmisartan also resulted in a reduction in the homeostatic model assessment of insulin resistance (HOMA-IR) (1.30 ± 0.65 to 1.10 ± 0.42; P < 0.05) at 6 weeks, but did not affect adiponectin or leptin levels. Addition of nifedipine (n = 8) resulted in a reduction in BP (158 ± 18/80 ± 13 to 131 ± 8/73 ± 13 mmHg; P < 0.01) at 18 weeks, but did not affect the HOMA-IR (1.10 ± 0.40 to 1.02 ± 0.56; ns). In patients who did not require addition of nifedipine (n = 8), BP levels remained nearly identical at 18 weeks (127 ± 13/73 ± 9 to 128 ± 13/68 ± 8 mmHg; ns), and HOMA-IR also remained nearly identical.
Conclusions: Telmisartan produced a favorable metabolic effect in hypertensive patients without preexisting metabolic disorders. Addition of nifedipine CR produced further BP-lowering effects, and resulted in maintenance of metabolic indices.

Keywords: metabolic effect, essential hypertension, combination therapy, telmisartan, nifedipine CR