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      Efficacy and safety of co‐administered telmisartan/amlodipine and rosuvastatin in subjects with hypertension and dyslipidemia

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      , MD 1 , , MD 1 , , MD 3 , , MD 4 , , MD 5 , , MD 6 , , MD 7 , , MD 8 , , MD 9 , , MD 10 , , MD 11 , , MD 12 , , MD 13 , , MD 14 , , MD 15 , , MD 16 , , MD 17 , , MD 18 , , MD 19 , , MD 20 , , MD 21 , , MD 22 , , MD 23 , , MD 24 , , MD 25 , , MD 26 , , MD 27 , , MD 28 , , MS 29 , , DVM 29 , , MD 2 ,
      Journal of Clinical Hypertension (Greenwich, Conn.)
      John Wiley and Sons Inc.
      amlodipine, dyslipidemia, hypertension, rosuvastatin, telmisartan

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          Abstract

          Single risk factors, such as hypertension and dyslipidemia, can combine to exacerbate the development and severity of cardiovascular disease. Treatment goals may be more effectively achieved if multiple disease factors are targeted with combination treatment. We enrolled 202 patients who were randomly divided into the following three groups: telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg, telmisartan 80 mg + rosuvastatin 20 mg, and telmisartan/amlodipine 80/5 mg. The primary efficacy variables were changes from baseline in mean sitting systolic blood pressure (MSSBP) between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg at 8 weeks, and the percent changes from baseline in low‐density lipoprotein (LDL) cholesterol between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg at 8 weeks. The secondary efficacy variables were changes in MSSBP, mean sitting diastolic blood pressure (MSDBP), LDL cholesterol and other lipid levels at 4 weeks and 8 weeks, as well as observed adverse events during follow‐up. There were no significant differences between the three groups in demographic characteristics and no significant difference among the three groups in terms of baseline characteristics for the validity evaluation variables. The mean overall treatment compliance in the three groups was, respectively, 98.42%, 96.68%, and 98.12%, indicating strong compliance for all patients. The Least‐Square (LS) mean (SE) for changes in MSSBP in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg) groups were −19.3 (2.68) mm Hg and −6.69 (2.76) mm Hg. The difference between the two groups was significant (−12.60 (2.77) mm Hg, 95% CI −18.06 to −7.14, P < .0001). The LS Mean for the percent changes from baseline in LDL cholesterol in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg) groups were −52.45 (3.23) % and 2.68 (3.15) %. The difference between the two groups was significant (−55.13 (3.20) %, 95% CI −61.45 to −48.81, P < .0001). There were no adverse events leading to discontinuation or death. Combined administration of telmisartan/amlodipine 80/5 mg and rosuvastatin 20 mg for the treatment of hypertensive patients with dyslipidemia significantly reduces blood pressure and improves lipid control. ClinicalTrials.gov identifier: NCT03067688.

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          Most cited references25

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          2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

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            Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.

            Results of previous randomised trials have shown that interventions that lower LDL cholesterol concentrations can significantly reduce the incidence of coronary heart disease (CHD) and other major vascular events in a wide range of individuals. But each separate trial has limited power to assess particular outcomes or particular categories of participant. A prospective meta-analysis of data from 90,056 individuals in 14 randomised trials of statins was done. Weighted estimates were obtained of effects on different clinical outcomes per 1.0 mmol/L reduction in LDL cholesterol. During a mean of 5 years, there were 8186 deaths, 14,348 individuals had major vascular events, and 5103 developed cancer. Mean LDL cholesterol differences at 1 year ranged from 0.35 mmol/L to 1.77 mmol/L (mean 1.09) in these trials. There was a 12% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol (rate ratio [RR] 0.88, 95% CI 0.84-0.91; p<0.0001). This reflected a 19% reduction in coronary mortality (0.81, 0.76-0.85; p<0.0001), and non-significant reductions in non-coronary vascular mortality (0.93, 0.83-1.03; p=0.2) and non-vascular mortality (0.95, 0.90-1.01; p=0.1). There were corresponding reductions in myocardial infarction or coronary death (0.77, 0.74-0.80; p<0.0001), in the need for coronary revascularisation (0.76, 0.73-0.80; p<0.0001), in fatal or non-fatal stroke (0.83, 0.78-0.88; p<0.0001), and, combining these, of 21% in any such major vascular event (0.79, 0.77-0.81; p<0.0001). The proportional reduction in major vascular events differed significantly (p<0.0001) according to the absolute reduction in LDL cholesterol achieved, but not otherwise. These benefits were significant within the first year, but were greater in subsequent years. Taking all years together, the overall reduction of about one fifth per mmol/L LDL cholesterol reduction translated into 48 (95% CI 39-57) fewer participants having major vascular events per 1000 among those with pre-existing CHD at baseline, compared with 25 (19-31) per 1000 among participants with no such history. There was no evidence that statins increased the incidence of cancer overall (1.00, 0.95-1.06; p=0.9) or at any particular site. Statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics. The absolute benefit relates chiefly to an individual's absolute risk of such events and to the absolute reduction in LDL cholesterol achieved. These findings reinforce the need to consider prolonged statin treatment with substantial LDL cholesterol reductions in all patients at high risk of any type of major vascular event.
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              ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).

              Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies’ Task forces on CVD prevention in clinical practice.2 – 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.
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                Author and article information

                Contributors
                hyosoo@snu.ac.kr
                Journal
                J Clin Hypertens (Greenwich)
                J Clin Hypertens (Greenwich)
                10.1111/(ISSN)1751-7176
                JCH
                Journal of Clinical Hypertension (Greenwich, Conn.)
                John Wiley and Sons Inc. (Hoboken )
                1524-6175
                1751-7176
                16 September 2020
                October 2020
                : 22
                : 10 ( doiID: 10.1111/jch.v22.10 )
                : 1835-1845
                Affiliations
                [ 1 ] Department of Cardiology Dong‐A University Hospital Busan Korea
                [ 2 ] Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
                [ 3 ] Division of Cardiology Department of Internal Medicine Asan Medical Center Seoul Korea
                [ 4 ] Division of Cardiology Department of Cardiovascular Center Korea University Anam Hospital Seoul Korea
                [ 5 ] Department of Internal Medicine Korea University Ansan Hospital Ansan Korea
                [ 6 ] Department of Cardiology CHA Bundang Medical Center CHA University Seongnam Korea
                [ 7 ] Division of Cardiology Department of Internal Medicine Kyung Hee University Hospital at Gangdong Seoul Korea
                [ 8 ] Division of Cardiology Department of Internal Medicine Pusan National University Hospital Busan Korea
                [ 9 ] Department of Cardiology Ajou University School of Medicine Suwon Korea
                [ 10 ] Division of Cardiology Gachon University Gil Medical Center Incheon Korea
                [ 11 ] Department of Internal Medicine Kyung Hee University Hospital Seoul Korea
                [ 12 ] Cardiovascular Center Dongguk University Ilsan Hospital Goyang Korea
                [ 13 ] Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Korea
                [ 14 ] Division of Cardiology Daegu Catholic University Medical Center Daegu Korea
                [ 15 ] Division of Cardiology Department of Internal Medicine Wonju Severance Christian Hospital Yonsei University Wonju College of Medicine Wonju Korea
                [ 16 ] Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Korea
                [ 17 ] Department of Cardiology in Internal Medicine Chungnam National University Hospital Chungnam National University College of Medicine Daejeon Korea
                [ 18 ] Department of Internal Medicine College of Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea
                [ 19 ] Department of Internal Medicine Korea University Guro Hospital Seoul Korea
                [ 20 ] Division of Cardiology Department of Internal Medicine Soonchunhyang University Seoul Hospital Seoul Korea
                [ 21 ] Department of Internal Medicine Hanyang University College of Medicine Seoul Korea
                [ 22 ] Division of Cardiology Department of Internal Medicine Pusan National University Yangsan Hospital Yangsan Korea
                [ 23 ] Division of Cardiology Department of Internal Medicine Kangbuk Samsung Hospital Sungkyunkwan University Seoul Korea
                [ 24 ] Department of Internal Medicine College of Medicine Gyeongsang National University Jinju Korea
                [ 25 ] Department of Cardiology Ewha Womans University College of Medicine Seoul Korea
                [ 26 ] Cardiovascular Center Seoul National University Bundang Hospital Seongnam Korea
                [ 27 ] Department of Internal Medicine Busan Paik Hospital Inje University College of Medicine Busan Korea
                [ 28 ] Division of Cardiology Department of Internal Medicine Keimyung University Dongsan Medical Center Daegu Korea
                [ 29 ] Yuhan Research Institute Yuhan Corporation Yongin Korea
                Author notes
                [*] [* ] Correspondence

                Hyo‐Soo Kim, MD, PhD, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital 101 Daehak‐ro, Jongro‐gu, Seoul, 03080, Korea.

                Email: hyosoo@ 123456snu.ac.kr

                Author information
                https://orcid.org/0000-0001-9654-9257
                https://orcid.org/0000-0001-6706-6504
                https://orcid.org/0000-0003-0847-5329
                Article
                JCH13893
                10.1111/jch.13893
                7692919
                32937023
                8a21acc0-d050-41ab-bd71-17e57c46ad62
                © 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 03 April 2020
                : 05 May 2020
                : 06 May 2020
                Page count
                Figures: 3, Tables: 4, Pages: 11, Words: 6415
                Funding
                Funded by: Yuhan Corporation
                Categories
                Original Paper
                Combination Therapy
                Custom metadata
                2.0
                October 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.4 mode:remove_FC converted:27.11.2020

                amlodipine,dyslipidemia,hypertension,rosuvastatin,telmisartan

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