Importance of a fixed combination of telmisartan and amlodipine for the treatment of hypertension

Patients with moderate to severe hypertension frequently require>or=2 antihypertensives to achieve blood pressure (BP) control. The combination telmisartan/amlodipine is especially suitable for the treatment of severely hypertensive, high-risk patients, because it offers a substantial and sustained 24-h BP-lowering effect and is well tolerated in a range of patients with hypertension, who are at risk for cardiovascular events. ACCOMPLISH was the first trial to test two fixed-dose combinations (the angiotensin-converting enzyme inhibitor [ACEi] benazepril in combination with either the diuretic hydrochlorothiazide [HCTZ] or the calcium channel blocker amlodipine). It was shown that a combination including amlodipine was superior to that including HCTZ in reducing the risk of cardiovascular events and death among high-risk patients. Results of the ONTARGET study comparing telmisartan with ramipril showed that telmisartan was an equally effective alternative to ramipril and less likely to cause angioedema. The telmisartan/amlodipine combination is therefore a particularly attractive choice for difficult-to-control hypertensive patients at cardiovascular risk, including those with diabetes, or those who are obese, elderly, not controlled by amlodipine monotherapy, or who are intolerant to ACEi.