A comparative study to determine the clinical efficacy of Ramipril versus combination of Ramipril and Telmisartan in reducing microalbuminuria associated with grade 2 hypertension

Abstract

Inhibition of the renin-angiotensin system causes a reduction in urinary protein excretion. It is uncertain whether Angiotensin receptor blockers (ARBs) are equally effective antiproteinuric agents as Angiotensin converting Enzyme (ACE) inhibitors, or whether the combination of ACE inhibitors with ARBs is preferable to ACE inhibitor alone? Microalbuminuria is a prognostic marker for cardiovascular and renal risk. The objective of the study was to compare the clinical efficacy of Ramipril alone versus combination of Ramipril and Telmisartan by assessing the fall in B.P. and the improvement in the degree of microalbuminuria in stage II hypertensive patients. 60 patients of stage II hypertension without having any other cause of microalbuminuria were selected as subjects for the present study and were randomly distributed in to 2 groups- Group A included 30 patients who were given Ramipril 5 mg/ day and Group B included the same number of patients who were given a combination of Ramipril 5 mg/day and Telmisartan 40 mg/day. Baseline parameters included were measurement of Systolic, diastolic blood pressure and mean arterial pressure; microalbuminuria, blood urea, serum creatinine and serum potassium estimations. The drugs under trial were given for 20 weeks. Microalbuminuria was determined at 0 and 20 weeks. The mean percentage fall in microalbuminuria and mean arterial pressure were statistically highly significant (p<0.0001) with combination of Ramipril and Telmisartan (Group B) in comparison to Ramipril (Group A) alone. A highly significant (p‹ 0.0001) mean percentage increase in potassium level was observed in group B at the end of 20 weeks. The side effects were less observed in the combination group. Thus to conclude the combination of Ramipril and Telmisartan provides superior blood pressure (BP) lowering and target organ protection than Ramipril alone, hence the combination of Ramipril and Telmisartan is a better choice to treat and to prevent the progression of the disease.

Keywords: Hypertension; Microalbuminuria; Ramipril; Telmisartan