Effects of telmisartan and perindopril combination on hypertension and cardiovascular damage

PurposeCombined therapy is considered when monotherapy fails to control blood pressure (BP). This study evaluated the effects of combined treatment with telmisartan (an angiotensin receptor blocker, ARB) and perindopril (an angiotensin-converting enzyme inhibitor, ACEI) on BP and cardiovascular damage.MethodsSpontaneously hypertensive rats (SHRs) were treated with telmisartan and perindopril at usual (high, average) or low (1/4 of the usual dose) doses, alone or in combination. BP and heart rate (HR) were measured using a telemetry system. Ligation-induced myocardial ischemia/reperfusion-injured SHRs were used to measure the infarct area and endothelial nitric oxide synthase (eNOS) expression in the ligated vessel area in response to combination treatment. The effects of the two drugs, alone or in combination, on neointima hyperplasia inhibition in cuff-placed C57BL/6 mice were evaluated.ResultsCombining the two drugs at a fixed dose resulted in the most significant reduction in BP; however, even the low-dose combination resulted in, without reflex tachycardia, a much greater reduction than the usual dose of perindopril and a similar reduction to the usual dose of telmisartan. The usual dose of each drug alone, but not in combination, reduced the infarct area. The drugs increased eNOS expression individually and in combination; however, there was no synergistic effect between the combined and alone groups.ConclusionThe low-dose combination of telmisartan and perindopril may help effectively lower BP with no additive effect on other cardiovascular outcomes and may be a viable clinical strategy.