Can I give rosuvastatin 10 mg OD for lipid control and increase telmisartan/amlo to 80/5 in a patient with eGFR impairment, hypertension, and BP 150/80 mmHg?

Management of Hypertension and Lipid Control in a Patient with Impaired Renal Function

For this 65-year-old male patient with eGFR impairment (serum creatinine 1.4 mg/dL), rosuvastatin 10 mg OD can be safely administered, and the telmisartan/amlodipine dose can be increased from 40/5 mg to 80/5 mg to achieve better blood pressure control.

Assessment of Renal Function

• Based on the patient's parameters (serum creatinine 1.4 mg/dL, weight 91 kg, age 65 years), the estimated GFR is likely between 45-60 mL/min/1.73m² (CKD stage 3a) 1
• Patients with eGFR <60 mL/min/1.73m² require careful medication selection and dosing adjustments for certain medications 1
• Regular monitoring of kidney function is recommended at least annually, with more frequent monitoring (twice yearly) for those with eGFR 30-60 mL/min/1.73m² 1

Statin Therapy in Impaired Renal Function

• Rosuvastatin 10 mg OD is appropriate for this patient with impaired renal function 1
• KDIGO guidelines recommend statin therapy for adults aged ≥50 years with CKD not on dialysis, regardless of lipid levels 1
• For patients with eGFR <60 mL/min/1.73m², KDIGO suggests avoiding high-intensity statins due to potential increased risk of adverse effects 1
• Rosuvastatin dose adjustment is not recommended until creatinine clearance is <30 mL/min/1.73m² 1
• Statins have been shown to reduce cardiovascular events in patients with CKD 1

Antihypertensive Management

• The patient's current BP of 150/80 mmHg is above the recommended target of <130/80 mmHg for patients with CKD 1
• Increasing telmisartan from 40 mg to 80 mg is appropriate for this patient with uncontrolled hypertension and CKD 1
• Telmisartan FDA labeling states: "No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis" 2
• The recommended dose of telmisartan for cardiovascular risk reduction is 80 mg once daily 2
• ARBs like telmisartan are recommended first-line therapy for hypertension in patients with CKD, particularly with albuminuria 1

Combination Therapy Considerations

• Combination therapy with telmisartan/amlodipine has shown significant efficacy in reducing blood pressure in patients with hypertension 3
• Fixed-dose combinations may improve medication adherence 1
• The combination of telmisartan/amlodipine with rosuvastatin has been studied and found to be effective and safe for patients with both hypertension and dyslipidemia 4, 5
• A pharmacokinetic study showed that when rosuvastatin, telmisartan, and amlodipine are coadministered, there are some increases in exposure to rosuvastatin and telmisartan, but these changes were not considered clinically significant 6

Monitoring Recommendations

• Monitor blood pressure regularly after dose adjustment 1
• Check renal function and electrolytes (particularly potassium) within 2-4 weeks after increasing ARB dose 1
• Monitor for potential adverse effects of statins, including muscle symptoms 1
• A transient reduction in eGFR (up to 25%) may occur after initiation or dose increase of ARBs but is generally not a reason to discontinue therapy unless severe 1

Conclusion

Based on current guidelines and evidence, rosuvastatin 10 mg OD is appropriate for lipid control in this patient with moderate renal impairment, and increasing telmisartan to 80 mg in the telmisartan/amlodipine combination is justified to achieve better blood pressure control.