Fixed combination in patients with arterial hypertension: focus on antihypertensive and nephroprotective properties of fixed combination of lisinopril and amlodipine (clinical example)

2020 ◽  
pp. 19-28
Author(s):  
E. Yu. Ebzeeva ◽  
O. D. Ostroumova ◽  
N. M. Doldo ◽  
E. E. Pavleeva
Keyword(s):  
Kidney Disease ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Adult Population ◽  
Secondary Damage ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Based Medicine ◽  
Modern Population

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.

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

Dynamics of central hemodynamic parameters and cytokine levels in patients with chronic kidney disease and arterial hypertension during combination therapy

2020 ◽  
pp. 46-56
Author(s):  
Tamara Muratovna Khokonova ◽  
Zaira Feliksovna Kharaeva ◽  
Rustam Khasanovich Keshokov ◽  
Sofiat Khasenovna Sizhazheva ◽  
Svetlana Sergeevna Solyanik
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Interleukin 10 ◽  
Aortic Pressure ◽  
Cytokine Levels ◽  
Central Hemodynamic ◽  
Artery Disease ◽  
Anti Inflammatory Cytokine

The effect of antihypertensive and hypolipidemic therapy with the use of a fixed combination of amlodipine, lisinopril and rosuvastatin on the parameters of cytokines (the level of the proinflammatory cytokine - interleukin-1β, anti-inflammatory cytokine - interleukin-10, ligand CD40 (CD40L)), central aortic pressure, arterial stiffness and the value of albuminuria in patients with stage 3 chronic kidney disease, both in combination with arterial hypertension (AH) of 1-2 degrees, and without it, and in patients with coronary artery disease in combination with AH. The results of the study allow to conclude that the proposed antihypertensive and hypolipidemic therapy significantly reduces the parameters of central hemodynamics and vascular stiffness, the levels of microalbuminuria (MAU) and blood creatinine in patients with stage 3 chronic kidney disease in combination with AH of 1-2 degrees, and significantly increases the values IL-10 in patients with hypertension and CKD.

Possibilities of using fosinopril in treatment of patients with chronic kidney disease in combination with cardiovascular diseases and diabetes mellitus

2021 ◽  
pp. 17-25
Author(s):  
E. Yu. Ebzeeva ◽  
O. D. Ostroumova ◽  
S. V. Batyukina ◽  
N. A. Shatalova ◽  
N. M. Doldo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Cardiovascular Diseases ◽  
Kidney Disease ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitor ◽  
The Body ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Secondary Damage

Chronic kidney disease is one of the most common diseases in general medical practice, due to their secondary damage to the kidneys in arterial hypertension, chronic heart failure, and diabetes mellitus. The coexistence of hypertension and diabetes increases the likelihood of developing chronic kidney failure tenfold. In turn, chronic kidney disease is an important independent risk factor for the development of cardiovascular complications, including fatal ones, due to the direct relationship of the pathogenetic mechanisms of cardiorenal relationships. Approaches to the treatment of chronic kidney disease should be aimed both at preventing the risks of developing renal dysfunction, and at treating existing pathology. The multifactorial nature of the disease and the complex etiopathogenetic relationships determine the need to optimize existing approaches to the treatment of chronic kidney disease in multimorbidity patients with concomitance cardiovascular diseases and diabetes mellitus. This is also due to the fact that, unlike other target organs, compensation for background disease does not always prevent further deterioration of kidney function. According to the recommendations of the main scientific communities, in such cases, it is advisable to start therapy with the most effective angiotensin-converting enzyme inhibitors that combine nephro-and cardioprotective effects and have a dual route of elimination from the body, which is especially important in multimorbidity, the aim to prevent polypharmacy, reduce the risk of drug interactions and, consequently, side effects. This article reviews the literature data indicating the high efficacy and safety of the angiotensin converting enzyme inhibitor fosinopril in patients with chronic kidney disease in combination with cardiovascular diseases and diabetes mellitus.

scholarly journals Nephroprotective in patients with metabolic syndrome: approaches to the appointment of antihypertensive drugs

2016 ◽  
Vol 13 (2) ◽  
pp. 77-83
Author(s):  
O D Ostroumova ◽  
A A Zykova ◽  
M L Maksimov
Keyword(s):  
Metabolic Syndrome ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Arterial Hypertension ◽  
Renal Damage ◽  
Antihypertensive Drugs ◽  
Prognostic Significance ◽  
Mechanisms Of Development ◽  
Selection Of

In the article shows the questions of prevalence, diagnosis and prognostic significance of renal damage in metabolic syndrome. Discusses the pathogenetic mechanisms of development and progression of chronic kidney disease in individuals with obesity. Approaches to selection of antihypertensive drugs, advantages and limitations of the major classes of antihypertensive drugs in the treatment of metabolic syndrome, arterial hypertension combined with renal disease.

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

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.

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

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. 

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.

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