Fixed dose combination of two antihypertensive drugs and statin in hypertensive patients in clinical practice

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

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Quality Of Life And Emotional Impact Of A Fixed Dose Combination Of Antihypertensive Drugs In Patients With Uncontrolled Hypertension

Value in Health ◽

10.1016/j.jval.2015.09.902 ◽

2015 ◽

Vol 18 (7) ◽

pp. A397

Author(s):

RE Schmieder ◽

E Fronk ◽

AF Alexandre ◽

P Bramlage

Keyword(s):

Quality Of Life ◽

Antihypertensive Drugs ◽

Fixed Dose Combination ◽

Uncontrolled Hypertension ◽

Fixed Dose ◽

Emotional Impact ◽

Dose Combination

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Efficacy and safety of azilsartan medoxomil/chlortalidone fixed-dose combination in hypertensive patients uncontrolled on azilsartan medoxomil alone: A randomized trial

Journal of Clinical Hypertension ◽

10.1111/jch.13376 ◽

2018 ◽

Vol 20 (10) ◽

pp. 1473-1484 ◽

Cited By ~ 1

Author(s):

David J. Collier ◽

Attila Juhasz ◽

Enrico Agabiti-Rosei ◽

Eric Lloyd ◽

Michie Hisada ◽

...

Keyword(s):

Randomized Trial ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Efficacy And Safety ◽

Hypertensive Patients ◽

Dose Combination ◽

Azilsartan Medoxomil

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BETTER MEMORY AND EXECUTIVE FUNCTIONS IN MIDDLE-AGED TREATMENT NAIVE HYPERTENSIVE PATIENTS RECEIVING FIXED-DOSE COMBINATION TREATMENT WITH PERINDOPRIL ARGININE/INDAPAMIDE

Journal of Hypertension ◽

10.1097/01.hjh.0000573536.35649.59 ◽

2019 ◽

Vol 37 ◽

pp. e277

Author(s):

T. Ostroumova ◽

O. Ostroumova ◽

E. Borisova ◽

V. Parfenov ◽

A. Kochetkov

Keyword(s):

Executive Functions ◽

Combination Treatment ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Middle Aged ◽

Hypertensive Patients ◽

Treatment Naïve ◽

Dose Combination

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A ramipril versus ramipril/amlodipin fix kombináció egyéves perzisztenciája hypertoniás betegekben

Orvosi Hetilap ◽

10.1556/650.2017.30882 ◽

2017 ◽

Vol 158 (42) ◽

pp. 1669-1673 ◽

Cited By ~ 1

Author(s):

Gábor Simonyi ◽

Tamás Ferenci

Keyword(s):

Blood Pressure ◽

Survival Analysis ◽

Combination Therapy ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Hypertensive Patients ◽

Persistence Rate ◽

Dose Combination ◽

One Year ◽

The One

Abstract: Introduction: In the treatment of hypertension avoiding adverse cardiovascular complications to achieve target blood pressure is essential. The appropriate drug selection, and if necessary to change to combination therapy, patients adherence is important which may help fixed dose combination. Aim: The aim of the authors was to investigate the one year adherence of the ramipril and ramipril/amlodipine fixed dose combination in hypertensive patients. Method: Prescriptions database of the National Health Insurance Fund in Hungary on pharmacy-claims was analysed between October 1, 2012 and September 30, 2013. The authors identified patients who filled prescriptions for ramipril monotherapy and fixed dose combinations of ramipril/amlodipine prescribed for the first time in hypertensive patients who have not received similar drugs in the previous year. To model the adherence, the apparatus of survival analysis was used, where “survival” was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable. Results: 92,546 patients met the inclusion criteria. During the trial period, ramipril therapy or ramipril/amlodipine fixed dose combination was started in 82,251 and 10,295 patients, respectively. One year persistence rate in patients with ramipril was 30% and 54% in patients with ramipril/amlodipine fixed dose combination therapy. Considering only the 360-day study period, the mean duration of persistence was 189.9 days in patients on ramipril and 270.6 days on ramipril/amlodipine fixed dose combination therapy. The hazard of discontinuation was more than twofold higher during treatment with ramipril compared with the use of the ramipril/amlodipine fixed dose combination therapy (HR = 2.11 [95% CI: 2.05–2.17], p<0,001). Conclusions: There is a significant difference between the one year persistence of ramipril and ramipril/amlodipine fixed dose combination therapy in hypertension. The result demonstrated that ramipril/amlodipine fixed dose combination therapy has a better one year persistence rate. When the next step is necessary to achieve target blood pressure, ramipril/amlodipine fixed dose combination therapy is preferable. Orv Hetil. 2017; 158(42): 1668–1673.

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