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570 EFFECTS OF TITRATION OF TELMISARTAN VERSUS ADDITION OF AMLODIPINE ON ALBUMINURIA IN PATIENTSTREATED WITH TELMISARTAN PLUS DIURETIC

Background: Microalbuminuria is closely associated with an increased risk of renal and cardiovascular adverse outcomes.We investigated effects ofup-titration of telmisartan and addition of amlodipine on albuminuria in patients treated with a standard dose of telmisartan combined with a low dose diuretic. Design and Methods: Hypertensive patients with type 2 diabetes mellitus and microalbuminuria under treatment with a combination of a standard dose of telmisartan (40 mg/day) and a low dose of trichlormethiazide (1 mg/day) were randomly assigned to switch their antihypertensive medicationeither to a high dose of telmisartan (80 mg/day) combined with trichlormethiazide (1 mg/day) (high-dose ARB group) or to a combination consisting of telmisartan (40 mg/day), trichlormethiazide (1 mg/day), and amlodipine (5 mg/day) (triple combination group) for 6 months. The primary endpoint was a reduction in urinary albumin levels. Results: Although blood pressure (BP) was reduced to a similar extent in the two regimens, patients receiving high-dose ARB showed a greater reduction in urinary albumin (–37.4 ± 16.9%) than those on the triple combination regimen(–8.9 ± 23.7%; P < 0.0001). The reduction of urinary albumin was correlated with the drop ofBP in the triple combination, but not high-dose ARB, group. Conclusions: Up-titration of telmisartan more effectively reduces urinary albumin than addition of amlodipine in hypertensive patients with diabetes treated with a combination of telmisartan and diuretic for the same degree of BP reduction. The beneficial effect of up-titration of telmisartan is greater than that expected from its BP lowering effect.