scholarly journals Multi-aspect approach to the optimization of pharmacotherapy of patients with arterial hypertension of high and very high risk

2018 ◽  
Vol 4 (4) ◽  
pp. 53-64
Author(s):  
Svetlana Gridina
Keyword(s):  
High Risk ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Treatment Options ◽  
Hypotensive Effect ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Hypotensive Action ◽  
Very High

Introduction: Personalization of pharmacotherapy of cardiovascular diseases is one of the urgent problems of cardiology. Material and methods: The study includes 120 patients with grades 2-3 arterial hypertension with the criteria of high and very high risk of developing cardiovascular complications. The patients were randomized into three groups with differentstarting regimens of pharmacotherapy – fixed and free combinations of ACE inhibitors and dihydropyridine CCB. Evaluation of the efficacy, safety and individualization of a therapy was carried out by using pharmacokinetic, pharmacoeconomic, sonographic, and laboratory methods. Results and discussion: Antihypertensive treatment with the inclusion of Amlodipine and Lisinopril or Ramipril in patients with arterial hypertension, having a slow and very slow oxidative metabolism phenotype, is characterized by the development of a more pronounced hypotensive effect in this group of patients (p<0.05-0.001) (Δ% SBP from 12.7 to 24.6 and from 19.6 to 27.9, respectively; Δ% DBP from 10.6 to 19.1 and from 15.9 to 23.6, respectively) in comparison to the group of patients with a fast phenotype (Δ% SBP from 6.42 to 9.34; Δ% DBP from 1.04 to 5.66), which allows administering a personalized pharmacotherapy. For patients with arterial hypertension of high and very high risk, the use of a fixed combination of Amlodipine and Lisinopril as a basic variant of the two-four-component therapy compared with treatment options based on free combinations of the studied drugs provided a significantly more pronounced decrease in systolic blood pressure (24.9%, 17.8 %, 19.0%, respectively, p<0.01), a greater degree of regression of left ventricular myocardial hypertrophy (8.70%, 5.67%, 5.84%, respectively, p<0.05), significant (p<0.05-0.001) improvement in a number of parameters of the patients’ quality of life, and was characterized by the greatest economic efficiency according to various criteria of hypotensive action. Conclusion: The results obtained in the study demonstrate the advantages of a fixed combination over free combinations of antihypertensive drugs and demonstrate the possibility of a pharmacokinetic approach to individualization of pharmacotherapy.

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 Evaluation of arterial hypertension control and treatment in daily practice of family physicians

Medicina ◽  
2010 ◽  
Vol 46 (10) ◽  
pp. 657
Author(s):  
Žaneta Petrulionienė ◽  
Daiva Apanavičienė
Keyword(s):  
High Risk ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Current Treatment ◽  
High Risk Group ◽  
Hypertension Control ◽  
Old Patients ◽  
Arterial Blood ◽  
Primary Arterial Hypertension ◽  
Very High

The objective of this study was to evaluate the percentage of patients with primary arterial hypertension treated with antihypertensive drug(s), who achieved target arterial blood pressure (ABP), and to compare the characteristics of patients with controlled and uncontrolled ABP, their current treatment, and treatment modifications. Material and methods. A total of 429 18–80-year-old patients with primary arterial hypertension treated for ≥1 year participated in this study. General practitioners collected data on patients’ demographic and clinical characteristics, current treatment for primary arterial hypertension, and treatment modifications. Results. According to physicians, 45.4% of patients achieved target ABP levels. Adequately controlled ABP was documented more often in the group of low and moderate cardiovascular risk than in high- and very high-risk group (n=141, 62.9% versus n=54, 26.3%; P<0.0001). Based on ABP measurements, 160 (37.3%) patients had ABP of <140/90 mm Hg. The majority of patients were treated with a combination of two (n=153, 35.7%) to three (n=144, 33.6%) antihypertensive drugs. Patients with uncontrolled ABP more frequently than patients with controlled ABP were given combination therapy. Treatment was not modified in 37.8% (n=162) of patients, more commonly in those with controlled ABP. Conclusions. The level of hypertension control in study population was far from optimal, especially in the group of patients at high- and very high-risk where target ABP was lower. Almost 12% of patients with uncontrolled ABP were still undergoing monotherapy, whereas 16% of patients were not recommended any modifications of antihypertensive treatment despite their ABP was not controlled.

scholarly journals EFFECT OF THERAPY WITH A FIXED COMBINATION OF PERINDOPRIL AND AMLODIPINE ON VASCULAR AGE AND 5-YEAR RISK OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AND MILLITUS DIABETES TYPE 2

2020 ◽  
Vol 74 (2) ◽  
pp. 157-162
Author(s):  
M.E. Statsenko ◽  
◽  
S.V. Turkina ◽  
V.V. Skibitsky ◽  
M.V. Derevyanchenko ◽  
...  
Keyword(s):  
High Risk ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Diabetes Type 2 ◽  
Cardiovascular Complications ◽  
Initial Increase ◽  
Average Risk ◽  
Medium Risk ◽  
Vascular Age

In recent years, the concept of cardiovascular risk factors, one of which is the process of vascular aging, has been of great interest. 30 patients with stage 2–3 of arterial hypertension and type 2 diabetes mellitus aged 45 to 65 years were included, including 23 women and 7 men. Patients after the washout period a fixed combination of perindopril with amlodipine (the original drug Prestans, AO Servier) in the form of tablets (perindopril arginine / amlodipine bezilat) were prescribed for 12 weeks, 1 time per day. Vascular age and 5-year risk of developing cardiovascular complications were calculated on the calculator app for smartphones ADVANTAGE AGE (Les laboratories Servier version 2, 2015). After 12-week therapy with a fixed combination of perindopril and amlodipine, the achievement of target blood pressure values was noted in 100 % of patients. The average passport age of the patients included in the study was (61,9 ± 4,4) [45; 65] years. In assessment vascular age, there was a statistically significant initial increase in vascular age above the passport age – (69,3 ± 8,5) [55; 89] years. 46,7 % of patients have an average risk of developing cardiovascular complications and 53,3 % of patients have a high risk of cardiovascular accidents. After 12 weeks of therapy with arginine perindopril and amlodipine bezilate, there was a significant decrease of vascular age to 63,1 ± 5,6 [51; 73] years, a decrease in the percentage of patients with high risk of cardiovascular complications to 23,4 % (p < 0,05), due to patients with average risk (53,3 %, at p < 0,05), and the appearance of patients (3,3 %) with a low risk of cardiovascular accidents within 5 years. In patients with arterial hypertension and diabetes millitus type 2, vascular age significantly increases in comparison with the passport age. The use of a fixed combination of perindopril arginine / amlodipine bezilate for 12 weeks in this category of patients significantly reduces the vascular age of patients and reduces the frequency of detection of patients with high and medium risk of cardiovascular accidents.

scholarly journals From the choice of antihypertensive drug to the choice of fixed combinations of antihypertensive drugs: a paradigm shift

2015 ◽  
Vol 12 (4) ◽  
pp. 23-29
Author(s):  
O D Ostroumova ◽  
O V Bondarets ◽  
I I Kopchenov ◽  
T F Guseva
Keyword(s):  
Angiotensin Ii ◽  
High Risk ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Calcium Antagonists ◽  
Clinical Benefit ◽  
Paradigm Shift ◽  
Antihypertensive Drugs ◽  
Evidence Base ◽  
Very High

The article considers modern approaches to treatment of arterial hypertension. Emphasizes the need for combination antihypertensive therapy, mainly fixed combinations of antihypertensive drugs, patients with high and very high risk already at the start of treatment. Discusses the advantages of combinations of blockers of receptors of angiotensin II to diuretics and calcium antagonists, as well as clinical situations in which these combinations are a priority. Considered the evidence base, pharmacokinetics and clinical benefit of the representative of a class of blockers of receptors for angiotensin II and losartan.

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 Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk

2019 ◽  
Vol 14 (6) ◽  
pp. 840-845
Author(s):  
O. Yu. Korennova ◽  
S. P. Podolnaya ◽  
E. P. Prihodko ◽  
E. A. Turusheva ◽  
S. N. Starinskaya ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Antihypertensive Efficacy ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Coronary Artery Stenting ◽  
History Of ◽  
Very High

Aim. To evaluate the antihypertensive efficacy and tolerability of a fixed combination of amlodipine and ramipril in hypertensive patients with very high cardiovascular risk. Material and methods. A retrospective cohort study of real clinical practice of prescribing antihypertensive drugs according to 255 medical records of outpatient hypertensive patients with a history of acute coronary syndrome (ACS) and coronary artery stenting was performed in the first part. An open observational study was performed in the second part. 69 people older than 18 years with a history of ACS and coronary artery stenting, without reaching the target blood pressure (BP) level while using free combinations of antihypertensive drugs and with indications for a fixed combination of ramipril and amlodipine were included into the study. Analysis of self-monitoring of BP, office BP, daily BP monitoring (ABPM) and patients’ adherence to treatment (Morisky-Green test) initially, after 4 and after 12 weeks of taking the fixed combination of ramipril and amlodipine was performed to assess the clinical efficacy of the studied drug. Results. It was found that 42.0% of patients did not follow the recommendations for regular intake of antihypertensive drugs. So, hypertension of all patients regarded as false-refractory, which was the basis for the prescription of the fixed combination of ramipril and amlodipine in accordance with clinical guidelines for the diagnosis and treatment of hypertension. After 4 weeks of therapy, there was significant decrease in office BP with the achievement and preservation of the target level by the 12th week, normalization to the 12th week of day and night BP variability in 54.9% of patients. 78.0% of patients followed medical recommendations for regular administration of antihypertensive drugs, none of the patients had adverse events. Conclusion. The use of fixed combinations of drugs, in particular, amlodipine and ramipril as a part of multicomponent therapy in hypertensive patients with very high cardiovascular risk, led to the achievement of target BP by the 4th week of therapy and stable preservation of antihypertensive effect in 12 weeks of treatment as well as gradual normalization of day and night BP variability in more than half of patients. Fixed combination of ramipril and amlodipine allowed to improve adherence of patients to cardiovascular diseases.

scholarly journals Comparative efficacy Noliprel forte and Ko-renitec at high risk arterial hypertension patients

2006 ◽  
Vol 12 (1) ◽  
pp. 56-58
Author(s):  
S. Nedogoda ◽  
T. Chalyabi ◽  
V. Tioina ◽  
Y. Brel ◽  
E. Prokhorova
Keyword(s):  
High Risk ◽  
Angiotensin Converting Enzyme ◽  
Arterial Hypertension ◽  
Cardiovascular Events ◽  
Antihypertensive Effect ◽  
Fixed Combination ◽  
Clinical Effects ◽  
Arterial Elasticity ◽  
Converting Enzyme ◽  
Comparative Efficacy

The aim of the study was to compare i he clinical efficacy and tolerance of fixed combinations of angiotensin-converting enzyme (ACE) and diuretic noliprel and co-renitec in patients with mild and moderate arterial hypertension with high risk of cardiovascular events. All investigated patients didn't achieved normal AP level with monotherapy. The study was blinded, randomised and performed in parallel groups (20 subjects in each group). The clinical effects were evaluated after 6 months of therapy by 1 tablet of noliprel-forte (4 mg / 12.5 mg) or co-renitec (20 mg / 12.5 mg). The antihypertensive effect was comparable for both dings, but fixed combination of noliprel-forte show advantage in reducing of LV hypertrophy and improvement of arterial elasticity.

scholarly journals Clinical and Pharmacological Approaches to the Prescription of Centrally Acting Antihypertensive Drugs for Uncontrolled Arterial Hypertension

2020 ◽  
Vol 16 (5) ◽  
pp. 815-821
Author(s):  
A. V. Strygin ◽  
B. E. Tolkachev ◽  
A. O. Strygina ◽  
A. M. Dotsenko
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Hypotensive Effect ◽  
Optimal Choice ◽  
Clinical Settings ◽  
Hypertensive Urgency ◽  
Drug Of Choice ◽  
Target Organs ◽  
Life Threatening ◽  
Hypertensive Therapy

Episodes of rapid increase in blood pressure due to uncontrolled arterial hypertension, previously known as a hypertensive urgency, is common clinical condition which many of practicing physicians are encountered daily. As a rule, these conditions are not life-threatening, however they could lead to target-organs damage if not promptly relieved. Therefore, clear evidence-based recommendations of optimal antihypertensive drug administration in these situations would provide more safe and effective therapy. Despite that, definite expert consensus regarding optimal choice of antihypertensive drugs to manage these patients have not been reached so far. The aim of the current review was to assess the results obtained from clinical trials regarding the safety and efficacy of moxonidine for urgent hypertensive therapy in patients with uncontrolled arterial hypertension admitted to emergency healthcare units as well as in those at the prehospital stage. Performed literature-based analysis revealed enough evidences proving that moxonidine can be administered in a single dose of 0.4 mg as a drug of choice in situations where prompt and stable hypotensive effect is desired. Results of comparative studies designed to closely match real clinical settings indicate that more adequate and sustainable therapeutic effect is achieved after moxonidine administration in comparison to other frequently used antihypertensive drugs.

scholarly journals Management of patients with combined arterial hypertension and aortic valve stenosis: a consensus document from the Council on Hypertension and Council on Valvular Heart Disease of the European Society of Cardiology, the European Association of Cardiovascular Imaging (EACVI), and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2020 ◽  
Author(s):  
Costantino Mancusi ◽  
Giovanni de Simone ◽  
Jana Brguljan Hitij ◽  
Isabella Sudano ◽  
Felix Mahfoud ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Arterial Hypertension ◽  
Aortic Valve Stenosis ◽  
European Association ◽  
Antihypertensive Drugs ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Expert Advice ◽  
Current Evidence ◽  
Drug Induced

Abstract Aortic valve stenosis (AS) is the third most common cardiovascular disease. The prevalence of both AS and arterial hypertension increases with age, and the conditions therefore often co-exist. Co-existence of AS and arterial hypertension is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Arterial hypertension may also influence grading of AS, leading to underestimation of the true AS severity. Current guidelines suggest re-assessing patients once arterial hypertension is controlled. Management of arterial hypertension in AS has historically been associated with prudence and concerns, mainly related to potential adverse consequences of drug-induced peripheral vasodilatation combined with reduced stroke volume due to the fixed LV outflow obstruction. Current evidence suggests that patients should be treated with antihypertensive drugs blocking the renin–angiotensin–aldosterone system, adding further drug classes when required, to achieve similar target blood pressure (BP) values as in hypertensive patients without AS. The introduction of transcatheter aortic valve implantation has revolutionized the management of patients with AS, but requires proper BP management during and following valve replacement. The purpose of this document is to review the recent evidence and provide practical expert advice on management of hypertension in patients with AS.

Sign in / Sign up

Export Citation Format

Share Document