Ramipril (5mg) + Telmisartan (40mg) + Hydrochlorothiazide (12.5mg) (Medical Monograph)

Overview

A triple-drug, fixed-dose combination (FDC) antihypertensive agent containing an ACE inhibitor (Ramipril), an ARB (Telmisartan), and a thiazide diuretic (Hydrochlorothiazide). This combination provides synergistic blood pressure lowering through complementary mechanisms of action, targeting the Renin-Angiotensin-Aldosterone System (RAAS) and sodium/fluid balance. It is indicated for patients with essential hypertension not adequately controlled on dual therapy. The combination may improve adherence and is a cost-effective strategy in the Indian context.

This combination exerts a multi-pronged attack on hypertension. Ramipril inhibits Angiotensin-Converting Enzyme (ACE), reducing the conversion of Angiotensin I to the potent vasoconstrictor Angiotensin II and decreasing aldosterone secretion. Telmisartan selectively and competitively blocks the binding of Angiotensin II to the AT1 receptor, inhibiting its vasoconstrictor and aldosterone-secreting effects regardless of the source of Angiotensin II. Hydrochlorothiazide inhibits sodium reabsorption in the distal convoluted tubule of the nephron, promoting natriuresis and diuresis, reducing plasma volume and peripheral vascular resistance. The combination provides additive/synergistic effects on BP reduction.