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Effects of telmisartan and perindopril combination on hypertension and cardiovascular damage

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Abstract

Purpose

Combined 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.

Methods

Spontaneously 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.

Results

Combining 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.

Conclusion

The 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.

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Acknowledgements

This work was supported by BK21 FOUR Program by Chungnam National University Research Grant, 2022.

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Authors and Affiliations

  1. Chungnam National University College of Pharmacy, Daejeon, 34134, Republic of Korea

    Do-Hyung Lee, Young-Eun Choi, Seong Pyo Lee, Hyung-Won Lee, Ye Won Sim, Jeong-Sook Park & Chang-Seon Myung

  2. Department of Pharmacology, Chungnam National University College of Pharmacy, 99 Daehak-ro (St.), Yuseong-gu, Daejeon, 34134, Republic of Korea

    Chang-Seon Myung

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  1. Do-Hyung Lee
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Correspondence to Chang-Seon Myung.

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All authors (D.-H. Lee, Y.-E. Choi, S.P. Lee, H.-W. Lee, Y.W. Sim, J.-S. Park, and C.-S. Myung) declare that they have no conflict of interest.

Research involving human and animal rights

This work complies with all ethical standards. All animal experiments were approved by the Chungnam National University Animal Care and Use Committee (2009-2-19).

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Lee, DH., Choi, YE., Lee, S.P. et al. Effects of telmisartan and perindopril combination on hypertension and cardiovascular damage. J. Pharm. Investig. 53, 563–570 (2023). https://doi.org/10.1007/s40005-023-00624-z

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