Combined pharmacotherapy of arterial hypertension. Overview fixed combination antihypertensive drugs

Arterial hypertension (AH) remains one of the most significant medical and social problems in the world, its prevalence among the adult population is 30–45%. Along with this, the modern population is characterized by a high incidence of chronic kidney disease (CKD), including due to their secondary damage in the framework of hypertension. In turn, CKD is an important independent risk factor for the development and progression of cardiovascular diseases, including fatal ones. The use of existing approaches to nephroprotection in the treatment of patients with hypertension will significantly improve the prognosis both in patients with risk factors for developing renal dysfunction and in patients with pre-existing kidney disease. According to current recommendations for hypertension in such clinical situations, therapy should begin with fixed combinations of antihypertensive drugs. The combination of an angiotensin converting enzyme inhibitor (ACE) and a dihydropyridine calcium channel blocker (CCВ) demonstrated the greatest effectiveness according to evidence-based medicine in patients with high-risk hypertension, including from the standpoint of nephroprotection. In the presented clinical case, the successful use of a fixed combination of ACE and CCВ in a patient with hypertension and microalbuminuria is described.

Download Full-text

A new fixed combination of perindopril, indapamide and amlodipine. "Three in one" is the way to improve the results of arterial hypertension treatment

Systemic Hypertension ◽

10.26442/sg29195 ◽

2017 ◽

Vol 14 (2) ◽

pp. 65-68

Author(s):

E A Temnikova

Keyword(s):

Arterial Hypertension ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Patient Adherence ◽

Difficult Problem ◽

Pressure Level ◽

International Studies ◽

Hypertension Treatment ◽

Triple Combination ◽

Adherence To Treatment

The management of patients with arterial hypertension is a difficult problem even if use the modern antihypertensive drugs. The reasons of the inadequate control to arterial pressure level during the treatment are different. The application fixed combinations of antihypertensive drugs improves the results of therapy, weigh with separate pathogenetic mechanisms of blood pressure increasing and the counterregulatory effects of the treatment each components of the combination. The use of fixed combinations significantly increases patient adherence to treatment. A new fixed triple combination of perindopril, indapamide, amlodipine expands therapeutic options for the treatment arterial hypertension. The effectiveness of the use of each of the components and their combination is proved in large international studies.

Download Full-text

Fixed combination of lercanidipine with enalapril - pharmacological features, clinical feasibility, advantages in the treatment of hypertension

Medicine of Ukraine ◽

10.37987/1997-9894.2021.4(250).238118 ◽

2021 ◽

pp. 21-24

Author(s):

P. О. Lazarev

Keyword(s):

Oxidative Stress ◽

Blood Pressure ◽

Arterial Hypertension ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Mechanisms Of Action ◽

High Efficacy ◽

National Guidelines ◽

Treatment Of Hypertension ◽

And Oxidative Stress

According to current international and national guidelines for the management of arterial hypertension preference is given to the use of fixed combinations of antihypertensive drugs of different classes, thus increasing the effectiveness of therapy acting in a complementary manner to affect different pathogenic mechanisms of arterial hypertension and reducing the frequency of side effects. A fixed combination of lercanidipine and enalapril contains antihypertensive drugs that have complementary mechanisms of action. This combination effectively reduces blood pressure, has high efficacy and tolerability, it may provide an additive effect on macro- and microvascular structures, arterial stiffness and oxidative stress. It has a beneficial influence on renal function, especially in patients with comorbidities.

Download Full-text

The optimal combination of Lysinopril and Amlodipine for the treatment of patients with hypertension

International Professional Journal Medicine ◽

10.31082/1728-452x-2020-211-212-1-2-31-39 ◽

2020 ◽

Vol 1-2 (211-212) ◽

pp. 31-39

Author(s):

Gulnara Junusbekova ◽

◽

Meiramgul Tundybayeva ◽

Tatyana Leonovich ◽

Manshuk Yeshniyazova ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Cardiovascular Complications ◽

Antihypertensive Activity ◽

Daily Monitoring ◽

Very High

Arterial hypertension (AH) remains one of the most common diseases in the world. Reducing cardiovascular risk of mortality from cardiovascular complications is a priority in the treatment of hypertension. Targets of hypertension therapy is to achieve SBP/DBP <140/80 mm Hg. article, regardless of cardiovascular risk and comorbidity. The choice of antihypertensive therapy depends on blood pressure levels, the presence or absence of concomitant diseases, lesion of target organs. Effective and long-lasting control of AH proved by the use of combinations of antihypertensive drugs, including antagonists and ACE inhibitors. The purpose of the study. Evaluation of clinical efficacy and safety of fixed combination antihypertensive therapy using lisinopril combined with amlodipine in patients with hypertension. Material and methods. The study included 30 respondents from essential hypertension II-III degree (ESH/ESC, 2018) aged 35 to 75 years. Patients were treated with the schema a (lisinopril 10 mg, amlodipine 5 mg) and scheme b (lisinopril 20 mg, amlodipine 10 mg) fixed combination therapy with the drug VivaCor® once in the morning. The period of observation was 3 months. At the time of inclusion and at the end of the study all respondents was performed echocardiography, daily monitoring of blood pressure, evaluation of laboratory and instrumental methods of research. Results and discussion. The combination of lisinopril with amlodipine has a fairly high antihypertensive activity, provides a significant cardioprotective effect and is an integral part of antihypertensive therapy in the long-term strategy of administering patients with high hypertensive / very high total cardiovascular risk. Conclusions: 1. The use of a fixed combination of lisinopril and amlodipine in patients with hypertension instead of free or other two-component combinations leads to its target level within 3 months of therapy. 2. Taking a fixed combination of lisinopril and amlodipine is effective and safe. 3. Therapy using the combined drug VivaCor® in patients with high / very high risk of hypertension prevents further pathological remodeling of the heart. 4. The combination of amlodipine and lisinopril is metabolically neutral and well tolerated by patients. Keywords: arterial hypertension, lisinopril, amlodipine, VivaCor.

Download Full-text

Adherence to taking medicines as a basis for prevention of cardiovascular diseases

Medical Council ◽

10.21518/2079-701x-2019-5-54-59 ◽

2019 ◽

pp. 54-59

Author(s):

D. A. Napalkov ◽

A. A. Sokolova

Keyword(s):

Cardiovascular Diseases ◽

Arterial Hypertension ◽

Statin Therapy ◽

Healthcare System ◽

European Society ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Adherence To Treatment ◽

Prolonged Action ◽

Foreign Experience

The article discusses approaches to improving adherence to treatment with antihypertensive drugs and statins based on domestic and foreign experience, in particular, with the help of approaches proposed in the recommendations of the European Society of Cardiologists on Diagnostics and Treatment of Arterial Hypertension (ESC), updated in 2018. It is proposed to consider several levels to improve adherence: the level of the physician, the patient’s level, the level of prescription and the level of the healthcare system. The implementation of the principle of reducing the number of pills for the treatment of arterial hypertension can be achieved through the increased use of fixed combinations, such as lysinopril and prolonged action indapamide or lysinopril and amlodipine at the 1st stage of treatment selection. In the 2nd stage, a triple fixed combination of lysinopril, amlodipine and prolonged action indapamide can be used, thus maintaining the continuity of the therapy initiated. In patients with concomitant dyslipidemia, the authors suggest a fixed combination of lysinopril, amlodipine and rosuvastatin, which also improves adherence to statin therapy.

Download Full-text

Perspektivy klinicheskogo primeneniyanovoy fiksirovannoy kombinatsii -preparata Ko-Eksforzh v lecheniiarterial'noy gipertonii

Cardiosomatics ◽

10.26442/cs44978 ◽

2011 ◽

Vol 2 (1) ◽

pp. 64-71

Author(s):

Marina Gennad'evna Bubnova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Treatment Compliance ◽

Efficacy And Safety ◽

High Efficacy

Summary. This review is concerned with improving of blood pressure (BP) control in patients with arterial hypertension (AH). The reasons for the low treatment compliance and combined antihypertensive therapy benefits are analyzed. Data for futility of an extended use of antihypertensive drugs (AHD) fixed combinations are given. Studies demonstrating high efficacy and safety of a new triple fixed combination of amlodipine, valsartan and hydrochlorothiazide (HCT) are presented as well. Patients with hypertension, which should more actively use this combination of drugs, are signified.

Download Full-text

The comparative effects of different fixed combinations of antihypertensive drugs in patients with arterial hypertension and hypothyroidism

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2020.4.3544 ◽

2020 ◽

Vol 27 (4) ◽

pp. 35-44

Author(s):

V. I. Tseluyko ◽

D. A. Korchagina

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Blood Pressure Monitoring ◽

Myocardial Mass ◽

Pressure Monitoring ◽

Heart Remodeling ◽

Group 2

The aim – to assess the effects of different fixed double combinations of antihypertensive drugs and analyze their impact on heart remodeling in patients with arterial hypertension and hypothyroidism. Materials and methods. The study included 50 patients with hypertension and hypertension, which were divided into 2 groups by the method of blind envelopes of 25 people each. Patients in group 1 were assigned a fixed combination of perindopril with indapamide, patients in group 2 were assigned a fixed combination of perindopril with amlodipine. The groups were statistically compared by age, duration of hormonal substitution therapy, duration of hypertension, level of office SBP, DBP at inclusion in the study. In terms of body mass index, the study groups were comparable, but the number of obese patients was higher in group 2 (p=0.05). Observation of patients lasted 12 months.Results and discussion. The studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine provide a reduction in blood pressure in patients with hypertension with concomitant hypothyroidism according to the results of ambulatory blood pressure monitoring. Control of blood pressure in patients with arterial hypertension and concomitant hypothyroidism during a year of antihypertensive therapy provides a reduction in the severity of heart remodeling, the nature and extent of which depends on both the presence of obesity and the choice of a fixed combination of antihypertensive drugs.Conclusions. The results showed that in patients with AН and hypothyroidism achievement of euthyroid state contributes to BP reduction, but requires further administration of antihypertensive therapy. We studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine in patients with AG and associated hypothyroidism provide reliable blood pressure reduction according to the results of outpatient blood pressure monitoring (р<0.05). The fixed combination of perindopril with amlodipine compared with the fixed combination of perindopril with indapamide provides a significantly more significant effect on the regression of left ventricular myocardial hypertrophy, namely, a decrease in myocardial mass index by a degree of 2.7 in patients with obesity (р<0,01) myocardial mass index by body surface area in patients without obesity (p=0.06).

Download Full-text

The place of fixed antihypertensive drugs in modern therapy of arterial hypertension

Systemic Hypertension ◽

10.26442/2075082x.2020.4.200035 ◽

2021 ◽

Vol 17 (4) ◽

pp. 44-48

Author(s):

Tatiana V. Pinchuk ◽

Natalia V. Orlova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Calcium Channel ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Dual Therapy ◽

Evidence Base ◽

Target Blood Pressure ◽

High Dose ◽

Channel Blockers

The article provides information on modern approaches to the treatment of arterial hypertension. The historical information about therapy with combined antihypertensive drugs is given. Based on data from multicenter clinical trials, the article provides evidence of the benefits of dual and triple fixed drug combinations. Combinations of 1-adrenoreceptor antagonist bisoprolol and the dihydropyridine-type calcium channel blocker amlodipine are considered. The article highlights the advantages of each of the drugs, as well as their combination. It shows the benefits of a fixed combination of low and medium doses compared to high-dose monotherapy, such as efficacy in achieving target blood pressure, preventing cardiovascular events, increasing adherence to treatment, safety and development of side effects. It provides the evidence base for the effectiveness of a triple fixed combination of renin-angiotensin-aldosterone system blockers with calcium channel blockers and diuretics in achieving target blood pressure compared to a double fixed combination of members of these drug classes, which is due to additive effects. The safety and tolerability profiles were found to be more effective with triple therapy compared with dual therapy, which is also supported by studies.

Download Full-text

Multi-aspect approach to the optimization of pharmacotherapy of patients with arterial hypertension of high and very high risk

Research Results in Pharmacology ◽

10.3897/rrpharmacology.4.31952 ◽

2018 ◽

Vol 4 (4) ◽

pp. 53-64

Author(s):

Svetlana Gridina

Keyword(s):

High Risk ◽

Arterial Hypertension ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Treatment Options ◽

Hypotensive Effect ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Hypotensive Action ◽

Very High

Introduction: Personalization of pharmacotherapy of cardiovascular diseases is one of the urgent problems of cardiology. Material and methods: The study includes 120 patients with grades 2-3 arterial hypertension with the criteria of high and very high risk of developing cardiovascular complications. The patients were randomized into three groups with differentstarting regimens of pharmacotherapy – fixed and free combinations of ACE inhibitors and dihydropyridine CCB. Evaluation of the efficacy, safety and individualization of a therapy was carried out by using pharmacokinetic, pharmacoeconomic, sonographic, and laboratory methods. Results and discussion: Antihypertensive treatment with the inclusion of Amlodipine and Lisinopril or Ramipril in patients with arterial hypertension, having a slow and very slow oxidative metabolism phenotype, is characterized by the development of a more pronounced hypotensive effect in this group of patients (p<0.05-0.001) (Δ% SBP from 12.7 to 24.6 and from 19.6 to 27.9, respectively; Δ% DBP from 10.6 to 19.1 and from 15.9 to 23.6, respectively) in comparison to the group of patients with a fast phenotype (Δ% SBP from 6.42 to 9.34; Δ% DBP from 1.04 to 5.66), which allows administering a personalized pharmacotherapy. For patients with arterial hypertension of high and very high risk, the use of a fixed combination of Amlodipine and Lisinopril as a basic variant of the two-four-component therapy compared with treatment options based on free combinations of the studied drugs provided a significantly more pronounced decrease in systolic blood pressure (24.9%, 17.8 %, 19.0%, respectively, p<0.01), a greater degree of regression of left ventricular myocardial hypertrophy (8.70%, 5.67%, 5.84%, respectively, p<0.05), significant (p<0.05-0.001) improvement in a number of parameters of the patients’ quality of life, and was characterized by the greatest economic efficiency according to various criteria of hypotensive action. Conclusion: The results obtained in the study demonstrate the advantages of a fixed combination over free combinations of antihypertensive drugs and demonstrate the possibility of a pharmacokinetic approach to individualization of pharmacotherapy.

Download Full-text

The association of arterial hypertension and ischemic heart disease is the main problem in modern cardiology practice

Systemic Hypertension ◽

10.26442/sg29101 ◽

2015 ◽

Vol 12 (1) ◽

pp. 70-75

Author(s):

O D Ostroumova ◽

V A Dudaev ◽

V M Fomina

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Arterial Hypertension ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Ischemic Heart ◽

Actual Clinical Practice ◽

Basic Characteristics

This article deals with the epidemiological datashowing higher frequency of arterial hypertension (AH) in patients with ischemic heart disease (IHD). We discussed the basic characteristics of modern domestic and foreign recommendations for treating patients with combination of AH and IHD. We showed the target of blood pressure (BP) in this category of patients. This article deals with the priority groups of antihypertensive drugs, which have the advantages in the combination usage in patients with association of these diseases. We fixed special attention to the problem of BP variability (BPV) as a new risk factor for the development of coronary complications in patients with AH. We showed the possibility of fixed combination of perindopril and amlodipine in reducing interand intervisit BPV in patients with AH and IHD in actual clinical practice.

Download Full-text