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Hypertension Management Beyond Blood Pressure Control in India: An Expert Consensus on Angiotensin II Receptor
Jagdish Hiremath1, Ashok Kirpalani2, Deodatta Chafekar3
1Cardiology, Ruby Hall Clinic, Pune, IND.
Insights
Effective hypertension management in India requires addressing comorbidities like cardiovascular disease, chronic kidney disease, and type 2 diabetes. Expert consensus highlights combination therapy, including telmisartan and cilnidipine, for improved outcomes.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Hypertension is a major global cause of cardiovascular morbidity and mortality, with low control rates in India.
- Effective management necessitates addressing comorbidities like cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM).
Purpose of the Study:
- To develop an expert consensus on comprehensive hypertension management in India.
- To review current evidence on pharmacological and non-pharmacological interventions, including combination therapy for hypertension with comorbidities.
Main Methods:
- Multidisciplinary expert panel convened six advisory board meetings.
- Comprehensive literature review of RCTs and systematic reviews (2019-2025) from PubMed and Google Scholar.
- Focused on hypertension management, combination therapy, and comorbidity-specific strategies.
Main Results:
- Emphasized early screening for hypertension-mediated organ damage.
- Combination therapy, particularly telmisartan and cilnidipine, showed improved BP control, reduced proteinuria, and organ protection.
- Endorsed non-pharmacological interventions and fixed-dose combinations for adherence.
Conclusions:
- Supports a comprehensive, patient-centered approach to hypertension management in India.
- Telmisartan and cilnidipine combination shows potential benefits beyond BP reduction, based on current evidence.
- Further large-scale outcome trials are needed to confirm clinical benefits.
Abstract:
Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.
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