The single-pill combination or hybrid therapy in prevention of cardiovascular risk. Case reports

2021 ◽  
Vol 14 (1) ◽  
pp. 118-123
Author(s):  
Celina Wojciechowska
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Case Reports ◽  
Pressure Control ◽  
Cholesterol Concentration ◽  
Therapeutic Goals ◽  
Improve Blood Pressure Control ◽  
Single Pill ◽  
Different Doses

In polish population many patients with comorbid hypertension and hypercholesterolemia present low compliance and adherence to medical advising. The achievement of therapeutic goals of blood pressure control and hypercholesterolemia control was about 5,4% in WOBASZ II study. The therapy with antihypertensive drugs and statin in a single-pill combination (SPC) has recently been strengthened in the European and Polish guidelines for the treatment of arterial hypertension and hypercholesterolemia. It seems that therapy induction with SPC by reducing the number of pills to be taken daily could contribute to solve the problem of not undertaking or discontinuing treatment. The combination product present in different doses give possibility of optimization treatment. The use SCP on a larger scale could improve blood pressure control and cholesterol concentration reduction and prevent many of cardiovascular events.

scholarly journals Controlling resistant hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Renal Hypertension ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Aldosterone Antagonists ◽  
Improve Blood Pressure Control ◽  
Blood Pressures

Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.

scholarly journals Current Trends in the Treatment of Hypertension: Focus on Improving Prognosis. The Capabilities of an Amlodipine/Telmisartan Single-Pill Combination

2020 ◽  
Vol 15 (6) ◽  
pp. 906-917
Author(s):  
O. D. Ostroumova ◽  
A. I. Kochetkov
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Fixed Dose ◽  
Angiotensin Ii Receptor Blocker ◽  
Organ Protection ◽  
Modern Approach ◽  
Hypertensive Patients ◽  
Single Pill

Nowadays, the modern approach to antihypertensive therapy is to prescribe in the most hypertensive patients fixed-dose combinations of antihypertensive drugs as initial therapy. This concept is reflected in the latest revisions of European and Russian guidelines for the management of arterial hypertension (AH). Above mentioned principle is referred as “single-pill combination” strategy and is given high priority in clinical practice with a high evidence level. According to this approach, one of the possible first line single-pill combinations is the combination of an angiotensin II receptor blocker and a calcium channel blocker. In both classes, the reference and the best representatives include, respectively, telmisartan and amlodipine, as a result of broad experience in their practical application and, most importantly, extensive body of evidence regarding to its effectiveness and safety. Both antihypertensive drugs are distinguished by an extra-longstanding antihypertensive effect that exceeds such one of other representatives in their classes, thereby a stable blood pressure control throughout the day is realized, and most importantly, in the early morning hours, that are the most dangerous in terms of adverse cardiovascular and cerebrovascular events. Another important telmisartan and amlodipine characteristics is their targetorgan protective properties, which is realized at all the levels. In addition, telmisartan has a unique ability to activate PPAR-у-receptors and improves the carbohydrate metabolism and lipid profile, which is advantageous in patients with concomitant metabolic syndrome and diabetes mellitus. The telmisartan and amlodipine features and their proven ability to improve prognosis in hypertensive patients served as background for creating a singlepill combination of these antihypertensive drugs, which fully meet with the requirements of current clinical guidelines for AH management and in which these drugs synergistically coupling resulting in more effective blood pressure control, increases the reliability of target-organ protection, and also improves the therapy safety profile.

scholarly journals Identifying drug-related attributes to personalise antihypertensive agents: the outcome report of patients receiving metoprolol therapy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunyu Liu ◽  
Jing Xu ◽  
Ran Liu ◽  
Miye Wang ◽  
Yixuan Zhuo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Data Visualisation ◽  
Serum Cystatin C ◽  
Improve Blood Pressure Control

Abstract Background Currently, numerous antihypertensive drugs from different pharmacological classes are available; however, blood pressure control is achieved in only less than a third of patients treated for hypertension. Moreover, providing optimal and personalised treatment for hypertension is challenging. Therefore, in this study, we propose a ‘drug-related attributes’ sensitive spectrum. This novel concept can assist clinicians in selecting an optimal antihypertensive drug and improve blood pressure control after examining the attributes of a patient. Methods We collected clinical data on attributes related to hypertension and its therapy of inpatients from West China Hospital who received metoprolol therapy and constructed the sensitive spectrum using data-visualisation tools. Results Our analysis revealed that haematocrit, haemoglobin, serum creatinine, serum cystatin C, serum urea, age, sex, systolic pressure, diastolic pressure, pulse pressure, and heart rate are metoprolol-related attributes. Conclusion Our study showed that all metoprolol-related attributes identified are reasonable and helpful in improving the personalisation of metoprolol therapy. The proposed drug-related attributes spectrum can help personalise antihypertensive medication. Moreover, data-visualisation tools can be effectively used to mine the drug-related attributes sensitive spectrum.

Device Therapy of Hypertension

2021 ◽  
Vol 128 (7) ◽  
pp. 1080-1099
Author(s):  
Felix Mahfoud ◽  
Markus P. Schlaich ◽  
Melvin D. Lobo
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Blood Pressure Control ◽  
Carotid Body ◽  
Renal Denervation ◽  
Pressure Control ◽  
Hypertension Control ◽  
Baroreflex Activation Therapy ◽  
Improve Blood Pressure Control ◽  
Activation Therapy

In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.

Effect of strict blood pressure control on proteinuria in renal patients treated with different antihypertensive drugs

2001 ◽  
Vol 16 (suppl_1) ◽  
pp. 78-81 ◽  
Author(s):  
Soledad García de Vinuesa ◽  
José Luño ◽  
Francisco Gómez‐Campderá ◽  
Natalia Ridao ◽  
Mercedes Sánchez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control
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