Telmisartan: Blood Pressure aur Proteinuria Dono Ko Control Karta Hai
Haan, telmisartan (ek angiotensin-II receptor blocker) blood pressure ke saath-saath proteinuria ko bhi effectively control karta hai, aur yeh effect blood pressure reduction se independent bhi hota hai. 1, 2
Telmisartan Ka Dual Benefit
Telmisartan proteinuria ko kam karne mein bahut effective hai, chahe blood pressure control ho ya na ho. Yeh drug intraglomerular pressure ko reduce karke proteinuria ko kam karta hai, jo ek mechanism hai jo sirf blood pressure lowering se alag hai. 1, 2
Blood Pressure Control
- 24-hour blood pressure monitoring mein telmisartan ne systolic BP ko 135 se 122 mmHg aur diastolic BP ko 84 se 76 mmHg tak reduce kiya. 3
- Yeh effect din aur raat dono time equally effective rehta hai. 3
- Target blood pressure 130/80 mmHg se neeche hona chahiye chronic kidney disease aur proteinuria wale patients mein. 1
Proteinuria Reduction
- Telmisartan 80 mg daily ne proteinuria ko 37% (median) tak reduce kiya—1.60 g/24h se 1.06 g/24h tak. 3
- Yeh antiproteinuric effect blood pressure reduction se independent hai, matlab blood pressure kam na bhi ho to bhi proteinuria kam hota hai. 1, 2
- RAS blockers (jaise telmisartan) dusre antihypertensive agents se zyada effective hain albuminuria reduce karne mein. 1
Dosing Strategy: Standard vs High Dose
High-dose telmisartan (80 mg twice daily) standard dose (80 mg once daily) se zyada effective hai proteinuria reduce karne mein aur renal function preserve karne mein. 4
Standard Dose (80 mg Once Daily)
- Blood pressure control ke liye adequate hai. 3, 5
- Proteinuria mein moderate reduction hota hai. 3
- Lekin long-term mein serum creatinine badh sakta hai (1.6 se 2.7 mg/dL). 4
High Dose (80 mg Twice Daily)
- Proteinuria mein significantly zyada reduction hota hai standard dose ke comparison mein. 4
- Serum creatinine stable rehta hai (1.6 mg/dL par hi) aur creatinine clearance improve hota hai (67 se 74 mL/min). 4
- Blood pressure control standard dose jitna hi achha rehta hai, matlab extra BP lowering nahi hota. 1
- Yeh dose persistent high-level proteinuria (>500 mg/day) wale patients ke liye consider karna chahiye. 2
Combination Therapy
Jab telmisartan akele se blood pressure control nahi hota, to low-dose hydrochlorothiazide (12.5 mg) add karna chahiye. 6
- Telmisartan 40 mg + HCTZ 12.5 mg ka combination high-dose ARB monotherapy se zyada effective hai blood pressure aur proteinuria dono reduce karne mein. 6
- Systolic BP 153 se 133 mmHg aur diastolic BP 89 se 78 mmHg tak reduce hota hai. 6
- Proteinuria 3,749 se 2,474 mg/g creatinine tak kam hota hai. 6
- Dihydropyridine calcium channel blockers (jaise amlodipine) ko kabhi bhi telmisartan ke bina use nahi karna chahiye proteinuric kidney disease mein, kyunki woh proteinuria badha sakte hain. 1, 7
Monitoring Requirements
Treatment start karne ke 2-4 weeks baad serum creatinine aur potassium check karna zaroori hai. 1, 2
Acceptable Changes
- Serum creatinine mein 30% tak increase acceptable hai initial 4 weeks mein—yeh hemodynamic effect hai, kidney damage nahi. 1, 2
- Agar creatinine 30% se zyada badhe to dose reduce karna ya drug discontinue karna chahiye. 1
Safety Precautions
- Volume depletion (vomiting, diarrhea, inadequate fluid intake) ke time telmisartan aur diuretics hold kar dena chahiye acute kidney injury se bachne ke liye. 2, 8
- Telmisartan ko kabhi bhi ACE inhibitors ke saath combine nahi karna chahiye—yeh hypotension, hyperkalemia aur acute renal failure ka risk badhata hai. 2
- Serum potassium regularly monitor karna chahiye, especially advanced CKD mein. 2
Clinical Pearls
- Telmisartan diabetic aur non-diabetic dono types ke proteinuric kidney disease mein effective hai. 1, 3
- Sympathetic nerve activity ko bhi reduce karta hai, jo cardiovascular protection provide karta hai. 9
- Sodium restriction (<2.0 g/day) telmisartan ke antiproteinuric effect ko aur enhance karta hai. 2
- Therapy compliance bahut achhi hai kyunki once-daily dosing hai aur ACE inhibitor jaisi cough nahi hoti. 5