Description

Telmisartan 

• Class of medications: Angiotensin II receptor antagonists
• Newer angiotensin receptor blocker, very useful for the management of patients with mild-to-moderate hypertension.
• An important alternative as the first-line treatment of hypertension. 
• Produces greater reductions in both systolic blood pressure (SBP) & diastolic blood pressure (DBP) when compared with losartan. 
• Exert its PPARgamma enhancing activity clinically in obese or overweight type 2 diabetic patients as compared to candesartan.

Cilnidipine 

• Class of medications: Calcium blockers
• Centrally acting a2 adrenergic agonist, improves the ambulatory BP & HR profile by significant suppression of LVH in hypertensive CKD patients. 

• Reduce urinary proteinuria than amlodipine, in protein-uric and hypertensive patients treated with renin-angiotensin blockades. 

• Significantly decreases urinary albumin excretion without affecting serum creatinine concentration in hypertensive patients as compared to ACE inhibitor benazepril. 

Chlorthalidone 

• Class of medications: Thiazide-like diuretics 
• Chlorthalidone is a thiazide-like sulfonamide-derived diuretic that has been FDA approved since 1960 for the management of hypertension.
• Chlorthalidone is a first-line agent for the treatment of hypertension.  It is effective in the management of blood pressure by decreasing intravascular volume through promoted diuresis.
• By lowering the intravascular volume and osmotic gradient, the patient has reduced hydrostatic pressure leading to a clinical reduction in blood pressure.

COMBINATION

• A majority of hypertensive patients cannot be controlled by using one drug. JNC 7, as well as the European Society of Hypertension and Cardiology and the German Hypertension League, have stated that a large proportion of hypertensive patients will require a combination of two or more antihypertensive agents to achieve the desired target BP.