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

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.

scholarly journals Optimization of Outpatient Drug Care for Patients with Arterial Hypertension in Healthcare Conditions of the Republic of Kazakhstan based on Pharmacoeconomic Analysis

2020 ◽  
Vol 2 (37) ◽  
pp. 20-30
Author(s):  
Dinara Begesheva ◽  
Keyword(s):  
Arterial Hypertension ◽  
Calcium Channel ◽  
Fixed Combination ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Pharmacoeconomic Analysis ◽  
Channel Blockers ◽  
First Line Therapy ◽  
The Republic ◽  
European Society Of Cardiology

Abstract In the Republic of Kazakhstan, as in the whole world, cardiovascular diseases make the first place in terms of the “contribution” to the morbidity and mortality of the population. Arterial hypertension is the leading modifiable cause of cardiovascular and overall mortality in the world. Purpose of the study: To assess the pharmacoeconomic feasibility of using fixed combinations in the treatment of patients with arterial hypertension in the Republic of Kazakhstan. Methods. Review of domestic and foreign literature on the state of the management of patients with arterial hypertension, ABC / VEN- and frequency analyzes of the consumption of antihypertensive drugs, questioning patients for adherence to therapy and identifying their opinions about convenient therapy regimens, pharmacoeconomic analysis of the use of amlodipine in combination with lisinopril and their fixed combination. Results. In the updated version of the 2018 European Society of Cardiology guidelines, fixed combinations of two drugs in the form of one tablet strengthened their position as first-line therapy. Preferred dual combinations are those of the renin-angiotensin-aldosterone system blockers with calcium channel blockers or diuretics. Analysis of financing and coverage of the population with drugs at the outpatient level within the guaranteed volume of free medical care showed that arterial hypertension is the most costly nosology, while a tendency to inadequate provision of patients with antihypertensive drugs was revealed. The highest costs were associated with fixed combinations, despite the fact that they ranked only 5th in frequency of prescriptions, the most popular was the combination of an angiotensin-converting enzyme inhibitor with a calcium channel blocker (amlodipine / lisinopril). The results of the pharmacoeconomic analysis showed the feasibility of using a fixed combination of amlodipine / lisinopril, which makes it possible to assume the same trend in relation to other fixed combinations. Conclusions. The results obtained indicate the need to provide access for patients with arterial hypertension to fixed combination drugs. At the same time, the inclusion of these drugs in state drug supply programs may be accompanied by an increase in the burden on the health care system budget due to their high cost. The results of pharmacoeconomic studies should be the basis for making managerial decisions in the field of drug circulation. Key words: arterial hypertension, combined antihypertensive therapy, fixed combinations, pharmacoeconomic analysis

scholarly journals The effectiveness of combination antihypertensive therapy in patients with arterial hypertension and additional risk factors: obesity and obstructive sleep apnea syndrome

2018 ◽  
Vol 90 (12) ◽  
pp. 28-33 ◽  
Author(s):  
E M Elfimova ◽  
A Yu Litvin ◽  
I E Chazova
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Fixed Combination ◽  
Blood Pressure Monitoring ◽  
Target Blood Pressure ◽  
Effective Control ◽  
Pressure Monitoring ◽  
Male Patients

Aim. To study the effectiveness of a fixed combination of perindopril and amlodipine, with the subsequent addition of indapamide-retard in male patients with arterial hypertension (AH), obesity and severe sleep apnea (OSAS). Materials and methods. The study included 43 male patients in whom antihypertensive therapy titration was performed to achieve target blood pressure values with a fixed combination of calcium antagonist amlodipine (10 mg) and an angiotensin-converting inhibitor perindopril (5-10 mg) and indapamide-retard. At baseline and after 4-6 weeks, the effectiveness of antihypertensive therapy was monitored according to clinical measurements and ambulatory blood pressure monitoring (ABPM). An assessment of the carotid-femoral pulse wave velocity (cfPWV), aortic PWV (aoPWV), and ankle-brachial PWV (abPWV) was performed. Results and discussion. Target blood pressure values (according to clinical blood pressure, 24-hour blood pressure monitoring) during therapy with amlodipine 10 mg and perindopril 10 mg reached 65% of patients and another 30% reached target blood pressure when adding indapamide-retard 1.5 mg, that is - 95% of all patients included in the study. Upon reaching the target blood pressure values, a significant decrease in cfPWV, aoPWV and abPWV was observed. Conclusion. The fixed combination of perindopril arginine and amplodipine, with the addition of indapamide retard in male patients with hypertension 1st degree in the presence of obesity and severe OSAS allows to reach effective control of blood pressure and improve the elastic properties of large arteries, which can lead to a favorable organoprotective effect in this category of patients.

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

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.

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

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.

scholarly journals ADDITIONAL ANGIOPROTECTION AND METAbOLIC DISORDERS CORRECTION IN TREATMENT   OF ARTERIAL HYPERTENSION PATIENTS REACHED TARGET bLOOD PRESSURE LEVELS,   WITH FIxED COMbINATION OF PERINDOPRIL AND INDAPAMIDE

2018 ◽  
pp. 67-74
Author(s):  
S. V. Nedogod ◽  
A. A. Ledyaeva ◽  
E. V. Chumachek ◽  
V. V. Tsoma ◽  
A. S. Salasyuk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Augmentation Index ◽  
Applanation Tonometry ◽  
Target Blood Pressure ◽  
Age Assessment ◽  
Reactive Protein ◽  
Vascular Age ◽  
Vascular Elasticity

Aim. Evaluation of the ability of fixed combination of perindopril and indapamide (Noliprel Bi Forte) to achieve additional angioprotection in patients with arterial hypertension already reached target blood pressure (BP) at previous antihypertension therapy with losartan and hydrochlorothiazide (HCT).Material and methods. To open observational study, lasting 12 weeks, 25 patients included, those who had been taking losartan+HCT 100/12,5 mg. Results. During the study, all patients underwent 24 hour BP monitoring, applanation tonometry (augmentation index assessment and of central BP), measurement of pulse wave velocity (PWV), laboratory tests (lipids, fasting glucose, HOMA index, homocystein, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP), vascular age assessment). After shifting the therapy with losartan and HCT to combination perindopril and indapamide, BP decreased additionally by 3,9%, and diastolic BP — 5,4% (p<0,05). There was decrease of augmentation index by 9,4% and vascular age by 6,0% (p<0,05). There was also decrease of leptin level by 14,5%, hsCRP by 11,0%, and increase of adiponectin by 9,9% (p<0,05).Conclusion. The fixed combination perindopril and indapamide does have advantages for losartan and HCT combination in BP control, vascular elasticity improvement, and facilitates the decrease of body mass index, insulin resistance and non-infectious inflammation.

scholarly journals Pressure Natriuresis in Nitric Oxide-Deficient Hypertensive Rats

1999 ◽  
Vol 10 (1) ◽  
pp. 21-27
Author(s):  
LOURDES A. FORTEPIANI ◽  
ELENA RODRIGO ◽  
M. CLARA ORTÍZ ◽  
VICTORIA CACHOFEIRO ◽  
NOEMÍ M. ATUCHA ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Arterial Hypertension ◽  
Calcium Channel ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Renal Hemodynamics ◽  
High Dose ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Synthesis Inhibitor

Abstract. Chronic inhibition of nitric oxide (NO) synthesis has been shown to result in arterial hypertension and an important blunting of the pressure diuresis and natriuresis response (PDN). The mechanisms mediating these abnormalities are not completely understood. In the present study, the role of several antihypertensive drugs to ameliorate these alterations was evaluated. The PDN relationships have been evaluated in rats chronically (8 wk) treated with the NO synthesis inhibitor NG-nitro-L-arginine methyl ester (L-NAME; 40 mg/kg per d in the drinking water). Appropriate groups of rats were simultaneously treated with the angiotensin II receptor blocker candesartan at a low (1.5 mg/kg per d) and high (2.5 mg/kg per d) dose, with the converting enzyme inhibitor captopril (60 mg/kg per d) and with the calcium channel blocker verapamil (100 mg/kg per d). Chronic treatment with L-NAME significantly elevated mean BP (163.6 ± 6.5 mmHg versus 105.1 ± 3.6 in controls), reduced GFR and renal blood flow (RBF), and shifted to the right the PDN responses. Chronic administration of low-dose candesartan, captopril, or verapamil prevented the arterial hypertension and improved renal hemodynamics, but these levels were not completely normalized. High-dose administration also improved renal hemodynamics but induced reduced BP below the levels of control animals. Despite the normalization of the elevated BP, the PDN responses of these hypertensive treated groups were not normalized, and the slopes of the respective diuretic or natriuretic responses were very similar to those of the hypertensive untreated rats. The results indicate that interruption or blockade of the reninangiotensin system and calcium channel blockade are effective treatments for the NO-deficient arterial hypertension and renal vasoconstriction. However, the PDN responses are not normalized, and this finding suggests that the antihypertensive treatment is not enough to overcome the renal alterations associated with the chronic deficiency of NO.

scholarly journals Influence fixed combination therapy on arterial stiffness and erectile function in patients with arterial hypertension

2021 ◽  
Vol 28 (3) ◽  
pp. 20-29
Author(s):  
Yu. M. Sirenko ◽  
O. L. Rekovets ◽  
G. D. Radchenko ◽  
O. O. Torbas ◽  
S. M. Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Erectile Function ◽  
Fixed Combination ◽  
Dual Therapy ◽  
Office Blood Pressure ◽  
Combination Group ◽  
Triple Combination ◽  
Significant Difference

The aim – to evaluate the therapeutic efficacy and dynamics of arterial stiffness using сardio-ankle vascular index (CAVI), as well as the dynamics of erectile function in men of the generic fixed triple combination of valsartan/amlodipine/hydrochlorothiazide and a double fixed combination of valsartan/amlodipine in the treatment of patients with arterial hypertension II–III degree. Materials and methods. The study included patients with moderate and severe arterial hypertension without diabetes. Patients were divided into 2 groups by the method of envelopes of 25 each. The first group (n=25) was assigned a fixed triple combination of tablets valsartan/amlodipine/hydrochlorothiazide. The drug was administered 1 tablet (160 mg of valsartan/5 mg of amlodipine/12.5 mg of hydrochlorothiazide) once a day in the morning for 1 month. Patients in the second group (n=25) received a similar scheme of a double fixed combination of the drug valsartan/amlodipine. The drug was administered 1 tablet (160 mg of valsartan/5 mg of amlodipine) once a day in the morning for 1 month. If necessary, the target level of office blood pressure was less than 140/90 mm Hg, the dose was titrated to a daily dose of 320/10/12.5 mg (valsartan/amlodipine/hydrochlorothiazide) on a fixed triple combination and up to 320/10 mg (valsartan/amlodipine) on a fixed double combination. After 3 months of treatment there was control of therapy.Results and discussion. The study included 50 patients with moderate and severe hypertension. The average age of patients was 54.9±1.8 (25–75) years. The average BMI is 31.2±0.7 kg/m2. The average of the office of SBP and DBP at the beginning of the study were 161.7±1.8 mm Hg and 98.5±1.4 mm Hg in accordance. The office heart rate is 70.7±1.4 bpm. The decrease in the office blood pressure (SBP/DBP) was 35/19 mm Hg (р<0,05) on the double combination and 42/26 mm Hg (р<0,05) on the triple combination. Achieving target BP measurement in the office was 90.9 % – in the double combination and 95.7 % – in triple combination. In the dual combination group, withdrawal was observed in 3 (6 %) patients, in the triple combination group, withdrawal was observed in 4 (8 %) patients. There was a tendency to decrease the stiffness of the arterial wall in terms of cardio-vascular index CAVI, but there was no significant difference. CAVI right on dual therapy up to 8.68±0.57 units and after treatment 8.30±0.55 units. CAVI on the left on double therapy to 8.49±1.49 units and after treatment 8.17±1.49 units. CAVI right on triple therapy up to 8.86±0.39 units and after treatment 8.50±0.40 units from CAVI on the left in a triple combination up to 8.09±0.53 units and after treatment 8.27±0.36 units (p>0.05 for all values). No significant change in erectile function in men was detected during treatment.Conclusion. The dual (valsartan/amlodipine) and triple (valsartan/amlodipine/hydrochlorothiazide) fixed combination showed high antihypertensive efficacy, did not adversely affect metabolic disorders and erectile function in men, and inhibited the progression of stiffness.

scholarly journals Clinical practice guidelines on the diagnosis and treatment of patients with arterial hypertension and chronic obstructive pulmonary disease

2020 ◽  
Vol 17 (3) ◽  
pp. 7-34
Author(s):  
Irina E. Chazova ◽  
Vera A. Nevzorova ◽  
Lali G. Ambatiello ◽  
Tat’iana A. Brodskaia ◽  
Elena V. Oshchepkova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Chronic Obstructive ◽  
Channel Blockers ◽  
Obstructive Pulmonary Disease

One of the most common comorbid condition in people over 40 years old is: arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). The frequency of AH in patients with COPD varies from 6.8 to 76.3%, in average 34.3%. COPD is detected in every fourth patient with hypertension in the age group of 2564 years. The current trend towards an increase in life expectancy and therefore growing pool of elder cohort, will lead to a higher number of patients with comorbid disorders. Diagnosis and treatment of AH and COPD are determined by current clinical recommendations for both nosologies, however, a number of mutual pathophysiological mechanisms lead to a more severe course of these diseases with frequent exacerbations. The choice of antihypertensive therapy in patients with AH in combination with COPD should be given to drugs that can provide an adequate decrease in blood pressure in hypoxic conditions, especially at night and early morning hours, that have prolonged effect or could be prescribed in the evening, and to those that dont worsen bronchial obstruction or exacerbate hypoxia. Patients with AH and COPD should be given recommendations on lifestyle changes, especially smoking cessation. As initial therapy calcium channel blockers, angiotensin receptor blockers or angiotensin-converting enzyme inhibitors should be considered. Calcium channel blockers/renin-angiotensin system blockers should be considered as the first line for combination therapy. Thiazide, thiazide-like diuretics orb1-selective adrenergic blockers could be prescribed in case of insufficient antihypertensive response or depending on different clinical scenarios. Bronchodilators are the baseline therapy in COPD with concomitant AH. According to modern concepts, prescription of combination therapy with different mechanisms of action is the most proven and justified approach, which leads to a decrease in the frequency of exacerbations of COPD and amelioration of the symptoms. The choice of bronchodilator in the case of a COPD and AH combination, should take into account the proven long-term safety regarding the risk of cardiovascular complications. Tiotropium bromide as the monotherapy, including as a liquid inhaler and aclidinium/formoterol, tiotropium/oladeterol as combination therapy showed cardiovascular safety in the long-term studies. The escalation of COPD therapy with the need of inhaled steroids requires careful monitoring of blood pressure and, possibly, a revision of antihypertensive treatment leading to its escalation as well. COPD has many phenotypes requiring different medications, eg.: roflumilast, theophylline, macrolides and mucoactive drugs, that could also require tighter blood pressure control on patients with COPD and AH.

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

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.

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