Antihypertensive treatment with telmisartan in a cat with amlodipine-induced gingival hyperplasia

Use of amlodipine in the treatment of cats with systemic hypertension in Japan

An increase in systemic blood pressure causes bleeding and ischemia owing to peripheral vascular breakdown, leading to various forms of organ damage. The brain, eyes, kidneys, and cardiovascular system are known target organs for hypertension. To our knowledge, no reports in Japan describe, in detail, the types of antihypertensive drugs used to treat hypertension in cats or its underlying causes. Therefore, we aimed to investigate the use of antihypertensive drugs in domestic cats with hypertension in Japan, the causes of hypertension, and the vital prognosis of these patients. In the present survey, we found that amlodipine was used alone (60/80 cats) or concomitantly (20/80 cats) in all cat patients with hypertension in Japan. We also determined that blood pressure measurements were not yet routinely performed on cats at veterinary clinics in Japan. Furthermore, we have new information suggesting that amlodipine administration in cats with hypertension, which lowers systolic arterial pressure levels to within the normal range (<140 mmHg), may have a negative impact on their survival. Routine blood pressure measurements for cats during their regular health checkups can help identify hypertension, and proper interpretation of blood pressure readings can facilitate suitable treatment measures.

Feline comorbidities: The intermingled relationship between chronic kidney disease and hypertension

PRACTICAL RELEVANCE

Chronic kidney disease (CKD) is a highly prevalent disorder of senior cats. CKD is frequently diagnosed in association with hypertension, and the two conditions have an intermingled cause-and-effect relationship. Hypertensive target organ damage (TOD) to the eye, brain, heart and kidney significantly impacts the welfare of cats suffering from this comorbidity. Hypertension also drives proteinuria, which is an independent risk factor for progression and mortality in cats with CKD. Blood pressure monitoring and institution of effective antihypertensive treatment, where indicated, is therefore crucial in effective management of the feline CKD patient. Current guidelines recommend a target systolic blood pressure of <160 mmHg to minimise risk of TOD. Both amlodipine besylate and telmisartan are effective antihypertensive agents for use in these patients.

CLINICAL CHALLENGES

Clinical signs of hypertension may not be apparent to owners of affected cats until severe hypertensive TOD is present. Despite this, blood pressure monitoring in cats with CKD is still infrequently performed, and hypertension likely remains underdiagnosed in this population.

EVIDENCE BASE

This review is based upon evaluation of the currently available published literature, including relevant consensus statements. There is a large body of evidence supporting the association between hypertension and CKD in cats. However, significant aspects, such as the mechanisms behind this association, and effect of hypertension and antihypertensive treatment on mortality and progression of CKD, remain unclear. Further research is therefore required in order to improve understanding of these conditions.

Effect of telmisartan, angiotensin-converting enzyme inhibition, or both, on proteinuria and blood pressure in dogs

Background

The use of telmisartan (TEL), an angiotensin‐receptor blocker, for the control of systemic hypertension and proteinuria in dogs has not been reported extensively in a clinical setting.

Objectives

To determine the effects of an angiotensin‐converting enzyme inhibitor (ACEi) alone, ACEi in combination with TEL, or TEL alone on systolic blood pressure and proteinuria in dogs with protein losing nephropathy (PLN).

Animals

Forty‐two client‐owned dogs being treated for PLN.

Methods

Retrospective observational study of medical records of dogs at a university teaching hospital from 2012 to 2018 with the use of benazepril or enalapril alone, TEL alone, or both modalities for the management of PLN. Noninvasive blood pressure and urine protein to creatinine ratio (UPC) were compared among the treatment groups over time. A multivariable mixed‐effects linear regression model followed by post hoc analysis was used to estimate the marginal means and differences between the treatment groups.

Results

In comparison to group ACEi alone, combination treatment of an ACEi with TEL significantly reduced (P = .007) systolic blood pressure by 13 mm Hg (95% confidence interval [95% CI]: 4‐22 mm Hg). Angiotensin‐converting enzyme inhibitor + TEL in comparison to ACEi alone showed significant (P = .01) reduction in UPC of 2.5 (95% CI: 0.6‐4.4). The UPC of group ACEi + TEL was significantly lower (P = .01) in comparison to TEL alone by 3.8 (95% CI: 0.8‐6.8).

Conclusions and Clinical Importance

Telmisartan can be used to treat systemic hypertension and proteinuria in dogs.

Canine and Feline Oral Cavity Tumours and Tumour-like Lesions: a Retrospective Study of 486 Cases (2015-2017)

Oral cavity tumours and tumour-like lesions are common in dogs and cats, and their diagnosis and classification requires histopathological examination. The aim of this study was to analyse retrospectively oral cavity lesions in dogs and cats in order to evaluate the distribution of inflammatory, hyperplastic and neoplastic lesions manifested as tumours. A total of 486 oral cavity tumours and tumour-like lesions (340 canine; 146 feline), diagnosed routinely from 2015 to 2017, were included. The lesions were classified as inflammatory, hyperplastic or neoplastic (benign and malignant). Histopathological diagnosis was based on haematoxylin and eosin staining and, when necessary, May-Grünwald-Giemsa (for mast cell tumours) or Masson's Fontana (for melanomas) stains or immunohistochemistry (for CD3, CD79α and S100 markers). For dogs, 29.11% (99/340) of the lesions were benign tumours, 24.12% (82/340) were hyperplastic lesions and 14.7% (50/340) were inflammatory lesions. For cats, 4.79% (7/146) were benign tumours, 15.07% (22/146) were hyperplastic lesions and 57.53% (84/146) were inflammatory lesions. Furthermore, 23.24% (79/340) of canine cases were diagnosed with gingival hyperplasia and 19.12% (65/340) were diagnosed with peripheral odontogenic fibroma, while 43.84% (64/146) of feline cases were diagnosed with chronic lymphoplasmacytic stomatitis. Malignant tumours in dogs and cats constituted 32.06% (109/340) and 21.91% (32/146) of the lesions, respectively, with high-grade melanoma in dogs and squamous cell carcinoma in cats being the most common.

Safety and efficacy of orally administered telmisartan for the treatment of systemic hypertension in cats: Results of a double-blind, placebo-controlled, randomized clinical trial

BACKGROUND

Information regarding the efficacy of telmisartan for feline systemic arterial hypertension is limited.

OBJECTIVES

To evaluate the safety and efficacy of PO administered telmisartan solution in hypertensive cats.

ANIMALS

Client-owned cats with indirect systolic arterial blood pressure (SBP) of 160-200 mm Hg, based on multiple measurements.

METHODS

This multicenter trial consisted a 28-day, prospective, randomized, double-blind, placebo-controlled, parallel group, efficacy phase and a 154-day extended-use telmisartan phase. Hypertensive cats were randomly assigned to receive 1.5 mg telmisartan/kg PO q12h for 14 days, followed by 2 mg telmisartan/kg PO q24h, or equivalent volume of placebo. Systolic blood pressure was measured on days 0, 14, and 28. Change in SBP compared to baseline was calculated for days 14 and 28. Telmisartan efficacy was defined as significant decrease in SBP at day 14 compared to placebo and a clinically relevant (>20 mm Hg) decrease in SBP at day 28.

RESULTS

Two-hundred twenty-one cats were included. On day 14, least squares mean (95% confidence interval) SBP decrease was significantly larger in telmisartan-treated (-23.3 mm Hg [-28.2 to -18.3]) versus placebo-treated (-7.5 mm Hg [-13.6 to -1.5]) cats (P = .0005). On day 28, telmisartan treatment resulted in a clinically relevant SBP decrease (-23.9 mm Hg [-27.8 to -20.0]), whereas placebo did not (-11.6 mm Hg [-17.4 to -5.9 mm Hg]). The decrease in SBP persisted over the 6-month trial in telmisartan-treated cats.

CONCLUSIONS AND CLINICAL IMPORTANCE

Telmisartan significantly decreased SBP to a clinically relevant extent and was well tolerated in hypertensive cats.

Efficacy of long-term oral telmisartan treatment in cats with hypertension: Results of a prospective European clinical trial

Background

Efficacy of telmisartan in treating hypertension (HT) in cats has not been largely investigated.

Objective

Telmisartan oral solution effectively controls systolic arterial blood pressure (SABP) in hypertensive cats.

Animals

Two‐hundred eighty‐five client‐owned cats with systemic HT.

Methods

Prospective, multicenter, placebo‐controlled, randomized, double‐blinded study. Hypertensive cats diagnosed with SABP ≥160 mmHg and ≤200 mmHg without target‐organ‐damage were randomized (2 : 1 ratio) to receive 2 mg/kg telmisartan or placebo q24 PO. A 28‐day efficacy phase was followed by a 120‐day extended use phase. Efficacy was defined as significant difference in mean SABP reduction between telmisartan and placebo on Day 14 and group mean reduction in SABP of > 20 mmHg by telmisartan on Day 28 compared to baseline.

Results

Two‐hundred fifty‐two cats completed the efficacy and 144 cats the extended use phases. Mean SABP reduction at Day 14 differed significantly between groups (P < .001). Telmisartan reduced baseline SABP of 179 mmHg by 19.2 (95% confidence interval [CI]: 15.92‐22.52) and 24.6 (95% CI: 21.11‐28.14) mmHg at Days 14 and 28. The placebo group baseline SABP of 177 mmHg was reduced by 9.0 (95% CI: 5.30‐12.80) and 11.4 (95% CI: 7.94‐14.95) mmHg, respectively. Of note, 52% of telmisartan‐treated cats had SABP <150 mmHg at Day 28. Mean SABP reduction by telmisartan in severe (≥180 mmHg) and moderate HT (160‐179 mmHg) was comparable and persistent over time.

Conclusions and Clinical Importance

Telmisartan solution (PO) was effective in reducing SABP in hypertensive cats with SABP ≥160 mmHg and ≤200 mmHg.