• Telmisartan is the preferred ARB in hypertensive patients with diabetic and non-diabetic renal impairment

    February 3, 2015

    The arterial hypertension (AH) is a widespread disease, which often occurs in combination with other pathological conditions, worsening prognosis in a patient with metabolic syndrome or type 2 diabetes (DT2), and damage to the target organs, such as microalbuminuria or renal failure (RF).

    The combination of arterial hypertension and microalbuminuria or renal puts the patient in the high risk category for the occurrence of adverse cardiovascular events, and accordingly requires from the doctor a more aggressive approach for treatment and for combating the risk factors.

    The recommended treatment of patients with hypertension and renal impairment includes blockers of the renin angiotensin aldosterone system (RAAS), angiotensin converting enzyme inhibitors (ACEi) or ARB, because these drug classes prevent onset and/or slow the progression of nephropathy. The side effect profile of RAAS blockers, which determines the tolerability and the compliance with the therapy, provides advantage to angiotensin receptor blockers (ARB).

    For treatment of arterial hypertension eight ARBs are available: azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan и valsartan. They differ considerably from one another in terms of their pharmacokinetic and pharmacodynamic properties.

    Telmisartan has the longest half-life (approximately 24 hours) and the highest affinity to the type I receptors of angiotensin (AT) II. Furthermore, its lipophilicity is higher compared to the other ARB, which implies a larger volume of distribution and a better penetration into tissues.

    An additional effect of telmisartan is its function as a partial agonist of the peroxisome proliferator activated receptor gamma, leading to an advantage of the drug in patients with insulin resistance and impaired glucose regulation (DT2) in association with hypertension.

    The specified characteristics of telmisartan are expressed in several clinical advantages (e.g., long-term control of arterial insufficiency – BP and cardiovascular protection), which makes the medication particularly suitable for the treatment of hypertensive patients with DT2.

    VIVALDI (VALsartan in hypertensive type II Diabetic patients with overt nephropathy) provides the same degree of Nephroprotection as telmisartan and valsartan in diabetic patients with overt nephropathy, while in the same patient category the ability of telmisartan to reduce proteinuria is higher than that of losartan, despite the similar reduction in the values of BP with both medications.

    Telmisartan has proved its efficiency in the absence of hypertension. The study ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) covers 25 620 patients with vascular disease or DT2 and evidence of organ damage that were randomized for treatment with telmisartan, ramipril, or a combination of both medications.

    ONTARGET shows that both RAAS blockers are equally effective in influencing the primary endpoint (the combination of cardiovascular death, myocardial infarction, stroke and hospitalization for heart failure), but telmisartan is better tolerated.

    Based on the results of ONTARGET, telmisartan is the only ARB with an indication for the prevention of cardiovascular disease regardless of the values of BP, including in patients with DT2 with renal impairment.

    Tchaikapharma High Quality Medicines Inc. produces telmisartan under the trade Telsart.

    Telsart is in the NHIF list with the following code and price:
    Telsart 80 mg x 28 tabl. – CG201
    Free sale priceBGN 5.64
    Reimbursement BGN 2.64
    Additional payment by the patientBGN 3.00

    Telsart has the lowest price compared to all other competitors on the market – the additional payment under the NHIF is only BGN 3. For other telmisartans the patient has to pay between BGN5.15 and BGN 8.25. Estimated on the number of tablets Telsart again has the lowest price – BGN 0.11 per tablet.

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