DOI: https://doi.org/10.22141/2224-1485.5-6.66-67.2019.186044

Three-component combined antihypertensive therapy in patients with arterial hypertension and abdominal obesity. Data of 9-month observation

S.M. Koval, T.G. Starchenko, I.O. Snihurska, O.V. Mysnychenko, M.Yu. Penkova, K.O. Yushko, V.S. Konkova, O.M. Lytvynova, V.S. Lytvynov

Abstract


Background. The combination of primary arterial hypertension (AH) and abdominal obesity (AO) is characte-rized by resistance to antihypertensive therapy and a significant increase in cardiovascular risk. A promising approach to treatment of these patients is the early use of fixed-dose combinations of first-line antihypertensive drugs. The purpose of the work was to study the effectiveness of a fixed-dose combination of perindopril, indapamide and amlodipine in comparison with a non-fixed combination of these drugs in patients with AH and AO. Materials and methods. Seventy-five patients with AH stage 2–3 combined with AO class 1–2 (45 men and 30 women aged 48 to 66 years) were examined. They were divided into two subgroups depending on the type of antihypertensive therapy. The first subgroup (26 patients) received a non-fixed combination of perindopril, indapamide and amlodipine, the second subgroup (29 patients) — a fixed-dose combination of these drugs. The examination was carried out before treatment and after 3, 6 and 9 months. As a hypolipidemic drug, all patients received atorvastatin at a daily dose of 20 mg. This therapy was carried out against the background of recommendations for correcting the way of life. Results. It was found that the frequency of reaching the target levels of blood pressure in patients who received a fixed-dose combination of drugs was significantly higher after 9 months of treatment than in those who received a non-fixed combination. Adherence to therapy was also significantly higher in persons treated with a fixed-dose combination than that of patients taking a non-fixed combination of these drugs. According to the ambulatory blood pressure monitoring, a fixed-dose combination of prescribed drugs much better normalized parameters such as the average daily and average daytime diastolic blood pressure, average nighttime systolic and diastolic blood pressure, as well as the degree of nighttime decrease and average daily variability of systolic and diastolic blood pressure. The tested three-component fixed-dose combination made it possible to achieve target blood pressure levels at lower doses of applied components than a non-fixed combination. Conclusions. A fixed-dose combination of perindopril, indapamide and amlodipine compared with a non-fixed one in patients with AH and AO shows significantly greater antihypertensive efficacy, both according to office measurements and ambulatory blood pressure monitoring, against the background of better patients’ adherence to treatment. To achieve the target levels of blood pressure in persons with AH and AO, lower doses of a fixed-dose combination components are required than that of a non-fixed one.


Keywords


arterial hypertension; abdominal obesity; non-fixed combination of antihypertensive agents; fixed-dose combination of antihypertensive agents; target blood pressure; adherence to therapy

References


Серцево-судинні захворювання. Класифікація, стандарти діагностики та лікування. За ред. В.М. Коваленка, М.І. Лутая, Ю.М. Сіренка, О.С. Сичова, 3-тє вид., переробл. і доповн. Київ: МОРІОН, 2018. 224 с.

Chobanian A.V., Bakris G.L., Black H.R. et al. The se-venth report of the Joint National Committee on prevention, detection, evalution, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003. V. 289. P. 2560-2572.

Cifkova R. Epidemiology of hypertension. In: Manual of hypertension of the European Society of Hypertension. Ed. by

G. Mancia, G. Grassi and J. Redon. 2014. P. 1-13.

Waeber B., Feihl F., Mancia G. Blood pressure control in Europe. In: Manual of hypertension of the European Society of Hypertension. Ed. by G. Mancia, G. Grassi and J. Redon. 2014. P. 483-496.

Сіренко Ю.М., Маньковський Б.М. Артеріальні гіпертензії при ендокринних захворюваннях. Київ: Четверта хвиля, 2004. 165 с.

Manual of hypertension of the European Society of Hypertension. Ed. by G. Mancia, G. Grassi and J. Redon. 2014. 617 p.

Redon J., Martinez F., Fabia M.J. The metabolic syndrom in hypertension. In: Manual of hypertension of the European Society of Hypertension. Ed. by G. Mancia, G. Grassi and J. Redon. 2014. P. 433-442.

Victor R.G. Systemic hypertension: Mechanisms and diagnosis. In: Braunwald’s heart disease:a textbook of cardiovascular medicine. Ed. by D.L. Mann, D.P. Zipes, P. Libby, R.O. Bonow, E. Braunwald. 10th ed. 2015. P. 934-952.

Koval S., Snegurskaya I., Bozhko V., Myloslavsky D. Intercommunication between purine, carbohydrate metabolisms and processes of inflammation in patients with essential hypertension and metabolic syndrome. Journal of Hypertension. 2014. 32(e-Suppl. 1). Р. 363.

Chrostowska M. et al., Szyndler A., Wolf J., Narkiewicz. Obesity and sleep apnea. In: Manual of hypertension of the European Society of Hypertension. Ed. by G. Mancia, G. Grassi and J. Redon. 2014. P. 47-60.

Alberti K.G., Eckel R.G., Grundy S.M. et al. Harmonizing the metabolic syndrom-A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the study of obesity. Circulation. 2009. V. 120. Р. 1640-1645.

Koval S., Mysnichenko O., Snigurska I., Penkova M., Vysotskaya E., Bozhko V., Strashnenko A. Changes of vascular endothelial growth factor blood levels in patients with essential hypertension with and without abdominal obesity and stable angina pectoris. Journal of Hypertension. 2014. 32(e-Suppl. 1). P. 172.

Koval S., Mysnychenko O., Snegurska I., Penkova M., Vysotskaya E., Bozhko V., Strashnenko A. Blood levels of angiopoetin-2 proangiogenic and proinflammatory factor in patients with essential hypertension. Journal of Hypertension. 2015. 33(e-Suppl. 1). P. 340.

Borghi C., Cicero A.F.G., Ambrosioni E. The total cardiovascular risk. In: Manual of hypertension of the European Society of Hypertension. Ed. by G. Mancia, G. Grassi and J. Redon. 2014. P. 13-20.

2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018. 39. P. 3021-3104. doi:10.1093/eurheartj/ehy339.

Romero-Corral A., Somers V.K., Sierra-Johnson J. et al. Normal weigth obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur. Heart J. 2010. V. 31. Р. 737-746.

Коваль С.М. Проблеми класифікації і діагностики артеріальної гіпертензії та стратифікації ризику розвитку її ускладнень в світлі Європейських рекомендацій 2018 року (коментар до рекомендацій). Артеріальна гіпертензія. 2019. 1(63). C. 3-41.

Сіренко Ю.М. Про нові європейські рекомендації з артеріальної гіпертензії після їх першої презентації (коментар). Артериальная гипертензия. 2018. 3(59). C. 19-22.

Burnier M., Wuerzner G., Waeber B. Medical treatment of hypertension: monotherapy and combination therapy. In: Ma-nual of hypertension of the European Society of Hypertension.

Ed. by G. Mancia, G. Grassi and J. Redon. 2014. P. 309-318.

Radchenko G.D., Mushtenko L.O., Sirenko Yu.M. Influence of fixed-dose combination perindopril/amlodipine on target organ damage in patients with arterial hypertension with and without ischemic heart disease (results of EPHES trial). Vascular Health and Risk Management. 2018. 14. P. 265-278.

Сіренко Ю.М. Про нові європейські рекомендації з артеріальної гіипертензії після їх першої презентації (коментар). Артериальная гипертензия. 2018. 3(59). C. 19-22.

Dahlof B., Sever P.S., Poulter N.R. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumetiazide as required in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lavcet. 2005. V. 366. P. 895-906.

Mazza A., Lenti S., Schiavon L., Sacco A.P. et al. Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice. Adv. Ther. 2017. V. 34(4). P. 975-985.

Borghi C., Desideri G., Taddei S., Trimarco B. 3 dimentions in hypertension management. 2017. 62 p.

Koval S., Mysnychenko O., Snegurska I., Penkova M., Vysotskaya V. Dynamics of vascular endothelial growth factor and angiopoetin-2 blood levels in patients with hypertension and abdominal obesity after one year combined antihypertensive and hypolipidemic treatment. Journal of Hypertension. 2017. 35(e-Suppl. 2). P. 237.

Tóth K. PIANIST Investigators. Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am. J. Cardiovasc. Drugs. 2014. V. 14(2). P. 137-145.

Mourad J.J., Amodeo C., de Champvallins M., Brzozowska-Villatte R., Asmar R. Blood pressure-lowering efficacy and safety of рerindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled essential hypertension: a multicenter, randomized, double-blind, controlled trial. J. Hypertens. 2017. V. 35(7). P. 1481-1495.

Osterberg L., Blaschke T. Adherence to medication. N. Engl. J. Med. 2005. V. 353. P. 487-497.

Touboul P., Hennerici M., Meairs S. Mannheim Carotid Intima-Media Thickness and Plaque Consensus (2004–2006–2011): An Update on Behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc. Dis. 2012. Vol. 34, № 4. P. 290-296.

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT). Annals of the Rheumatic Diseases. 2006. Vol. 65. P. 1312-1324.

Коваль С.М., Старченко Т.Г., Пенькова М.Ю, Мисниченко О.В. и др. Клінічна ефективність фіксованої комбінації периндоприлу, індапаміду й амлодипіну у хворих на артеріальну гіпертензію з абдомінальним ожирінням. Результати 12-тижневого спостереження. Артеріальна гіпертензія. 2017. 5(55). С. 39-45.




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